Provider Demographics
NPI:1851441703
Name:SCHMUCKER, KEVIN R (PHD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:SCHMUCKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 JACOBS CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8716
Mailing Address - Country:US
Mailing Address - Phone:803-724-7924
Mailing Address - Fax:740-820-6924
Practice Address - Street 1:845 COUNTY HOUSE LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-8015
Practice Address - Country:US
Practice Address - Phone:740-373-2028
Practice Address - Fax:740-373-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1351103TC0700X
TX37508103TC0700X
OH5273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
620005432OtherRR MEDICARE
OH2055378Medicaid
620005432OtherRR MEDICARE