1003959743 NPI number — MRS. VERENA JOHANNA BURGER SCHMID LPC, CACII

Table of content: MRS. VERENA JOHANNA BURGER SCHMID LPC, CACII (NPI 1003959743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003959743 NPI number — MRS. VERENA JOHANNA BURGER SCHMID LPC, CACII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGER SCHMID
Provider First Name:
VERENA
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CACII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003959743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2913 COUNTY ROAD 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81226-9722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-248-8093
Provider Business Mailing Address Fax Number:
888-242-6614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 ROYAL GORGE BLVD
Provider Second Line Business Practice Location Address:
SUITE #228
Provider Business Practice Location Address City Name:
CANON CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-248-8093
Provider Business Practice Location Address Fax Number:
888-242-6614
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC2826 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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