Provider Demographics
NPI:1659470698
Name:SCHMOLL, MARK D (LCMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SCHMOLL
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-8000
Mailing Address - Fax:802-229-8030
Practice Address - Street 1:157 BARRE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3668
Practice Address - Country:US
Practice Address - Phone:802-229-8000
Practice Address - Fax:802-229-8030
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007318Medicaid
VT989026COtherMVP HEALTHCARE
VT2094293OtherCIGNA
VT00029906OtherBC/BS OF VT
VT360335OtherTRICARE