Provider Demographics
NPI:1619516457
Name:SCHAEFER, KIMBERLY (SEP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:SEP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SEP
Mailing Address - Street 1:4009 BANISTER LN STE 330
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8182
Mailing Address - Country:US
Mailing Address - Phone:512-507-0233
Mailing Address - Fax:
Practice Address - Street 1:4009 BANISTER LN STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8182
Practice Address - Country:US
Practice Address - Phone:512-507-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health