Provider Demographics
NPI:1578835120
Name:SCHROEDER, TERI (LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:GEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8127 MESA DR
Mailing Address - Street 2:#B206-360
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD STE 1140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8479
Practice Address - Country:US
Practice Address - Phone:512-843-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89446QOtherBCBS