Provider Demographics
NPI:1477617330
Name:SCHRAG, KEITH G (MDIV)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:SCHRAG
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S WALNUT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-7037
Mailing Address - Country:US
Mailing Address - Phone:515-232-3482
Mailing Address - Fax:
Practice Address - Street 1:233 S WALNUT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-7037
Practice Address - Country:US
Practice Address - Phone:515-232-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health