Provider Demographics
NPI:1780492793
Name:SCHAFER, BREAN (ALC, MS, CM)
Entity type:Individual
Prefix:
First Name:BREAN
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:ALC, MS, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8222
Mailing Address - Country:US
Mailing Address - Phone:217-414-5434
Mailing Address - Fax:
Practice Address - Street 1:2110 MCFARLAND BLVD E STE B
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5820
Practice Address - Country:US
Practice Address - Phone:217-414-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty