Provider Demographics
NPI:1710105796
Name:SCHOONOVER, CONNIE LEANN (MS, MED, LPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LEANN
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 PARKMOOR VILLAGE DR
Mailing Address - Street 2:STE. 108
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-6253
Mailing Address - Country:US
Mailing Address - Phone:719-659-2502
Mailing Address - Fax:719-623-0183
Practice Address - Street 1:3715 PARKMOOR VILLAGE DR
Practice Address - Street 2:STE. 108
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-6253
Practice Address - Country:US
Practice Address - Phone:719-659-2502
Practice Address - Fax:719-623-0183
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3529101YP2500X
TX12440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532842Medicaid