1477651875 NPI number — MS. DIANE JOSEPHINE SCHREADER LMFT

Table of content: MS. DIANE JOSEPHINE SCHREADER LMFT (NPI 1477651875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477651875 NPI number — MS. DIANE JOSEPHINE SCHREADER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHREADER
Provider First Name:
DIANE
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1477651875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7634 E SAN FERNANDO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-502-9344
Provider Business Mailing Address Fax Number:
480-483-3981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 NORTH HAYDEN RD
Provider Second Line Business Practice Location Address:
STE A104
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-443-3060
Provider Business Practice Location Address Fax Number:
480-483-3981
Provider Enumeration Date:
09/20/2006

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:  0263 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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