Provider Demographics
NPI:1710187711
Name:SCHARDEIN, JAMES KEITH II (CADC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEITH
Last Name:SCHARDEIN
Suffix:II
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-5201
Mailing Address - Country:US
Mailing Address - Phone:918-825-4872
Mailing Address - Fax:918-825-4873
Practice Address - Street 1:205 S ADAIR ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5201
Practice Address - Country:US
Practice Address - Phone:918-825-4872
Practice Address - Fax:918-825-4873
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)