Provider Demographics
NPI:1609912468
Name:SCHAACK, JOHN A (MS, LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SCHAACK
Suffix:
Gender:M
Credentials:MS, LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 14TH ST W
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3150
Mailing Address - Country:US
Mailing Address - Phone:406-294-9510
Mailing Address - Fax:406-294-9512
Practice Address - Street 1:1501 14TH ST W
Practice Address - Street 2:SUITE 230
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3150
Practice Address - Country:US
Practice Address - Phone:406-294-9510
Practice Address - Fax:406-294-9512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1137101YA0400X
MT511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256334Medicaid