Provider Demographics
NPI:1659423630
Name:SCHNEIDER, GERALD R (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:R
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:R
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3580 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7915
Mailing Address - Country:US
Mailing Address - Phone:253-798-6145
Mailing Address - Fax:
Practice Address - Street 1:3580 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7915
Practice Address - Country:US
Practice Address - Phone:253-798-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00005624OtherMENTAL HEALTH COUNSELOR