Provider Demographics
NPI:1821388240
Name:SCHAEFER, THOMAS MATHIAS (MA LISAC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MATHIAS
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:MA LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 W DESERT CREST PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-1007
Mailing Address - Country:US
Mailing Address - Phone:651-491-5305
Mailing Address - Fax:
Practice Address - Street 1:4735 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718
Practice Address - Country:US
Practice Address - Phone:520-647-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15088101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)