Basic Information
| Provider Information | |||||||||
| NPI: | 1881651776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LPC, PHD, CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27476 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH STREET | ||||||||
| Address2: | MAIL STOP 6225 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794306225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432592 | ||||||||
| FaxNumber: | 8067433244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 77721 | TX | N | Behavioral Health & Social Service Providers | Counselor | Professional | 104100000X | 6801066144 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 77721 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.