Provider Demographics
NPI:1497204713
Name:DEBRA SCHMIDT, LLC
Entity Type:Organization
Organization Name:DEBRA SCHMIDT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:320-247-4332
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-0846
Mailing Address - Country:US
Mailing Address - Phone:320-247-4332
Mailing Address - Fax:
Practice Address - Street 1:2700 1ST ST N STE 209
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4584
Practice Address - Country:US
Practice Address - Phone:320-247-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1915251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health