1093159261 NPI number — MRS. STACI LEE SCHNELL M.S., C.S., LMFT

Table of content: MRS. STACI LEE SCHNELL M.S., C.S., LMFT (NPI 1093159261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093159261 NPI number — MRS. STACI LEE SCHNELL M.S., C.S., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNELL
Provider First Name:
STACI
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.S., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
STACI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093159261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11011 SHERIDAN ST
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33026-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-951-2929
Provider Business Mailing Address Fax Number:
954-252-3767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12323 SW 55TH ST
Provider Second Line Business Practice Location Address:
SUITE 1003
Provider Business Practice Location Address City Name:
COOPER CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-680-1211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2013

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: 106H00000X , with the licence number:  MT2779 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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