Provider Demographics
NPI:1780105452
Name:SCHRADER, JAMES BRYAN (MA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRYAN
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEHAVIORAL HEATH RESPONSE
Mailing Address - Street 2:12648 OLIVE BLVD
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-628-6229
Mailing Address - Fax:
Practice Address - Street 1:12648 OLIVE BLVD
Practice Address - Street 2:BEHAVIORAL HEATH RESPONSE
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-628-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health