Basic Information
| Provider Information | |||||||||
| NPI: | 1063522498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEARLEY & SCHMITT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1433 FAIRFIELD DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787587244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124918444 | ||||||||
| FaxNumber: | 5124910226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1433 FAIRFIELD DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787587244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124918444 | ||||||||
| FaxNumber: | 5124910226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | KEARLEY | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5124918444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 00175U | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | 00175U | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0801X | 454908 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 155006302 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 1041C0700X | 155006301 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 155006301 | 05 | TX | MEDICAID | 155006302 | 05 | TX | MEDICAID |