1851425581 NPI number — MR. JON B SCHAFER MS, LPC, NCC, MAC

Table of content: MR. JON B SCHAFER MS, LPC, NCC, MAC (NPI 1851425581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851425581 NPI number — MR. JON B SCHAFER MS, LPC, NCC, MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFER
Provider First Name:
JON
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, NCC, MAC
Provider Gender Code:
M

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:
1851425581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 DEWITT LOOP
Provider Second Line Business Mailing Address:
FORT BELVOIR COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FORT BELVOIR
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22060-5285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-231-1171
Provider Business Mailing Address Fax Number:
571-231-1172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 DEWITT LOOP
Provider Second Line Business Practice Location Address:
CHILD AND ADOLESCENT PSYCHIATRY SERVICES CLINIC
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060-5285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-231-1171
Provider Business Practice Location Address Fax Number:
571-231-1172
Provider Enumeration Date:
03/15/2007

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: 101YA0400X , with the licence number:  2315 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2315 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11713524 . This is a "CAQH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51527447 . This is a "BCBSAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 200280923 . This is a "TAX ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51534981 . This is a "AMERICAN BEHAVIORAL HEALT" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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