Provider Demographics
NPI: | 1508146424 |
---|---|
Name: | SCHNEIDER, BRIAN W (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | BRIAN |
Middle Name: | W |
Last Name: | SCHNEIDER |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 179 PARKSIDE DR. |
Mailing Address - Street 2: | |
Mailing Address - City: | COLORADO SPRINGS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80910 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-572-6100 |
Mailing Address - Fax: | 719-572-6399 |
Practice Address - Street 1: | 4090 BRIARGATE PKWY |
Practice Address - Street 2: | |
Practice Address - City: | COLORADO SPRINGS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80920-7815 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-848-0000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-08-23 |
Last Update Date: | 2022-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X | ||
CO | 0003962 | 103T00000X |
CO | 3962 | 103T00000X |
CO | PSY.0003962 | 103TC2200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist |