Provider Demographics
NPI:1366964645
Name:SCHMOYER, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHMOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11246 69TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4576
Mailing Address - Country:US
Mailing Address - Phone:267-897-3447
Mailing Address - Fax:
Practice Address - Street 1:9000 QUANTRELLE AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-0139
Practice Address - Country:US
Practice Address - Phone:763-633-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty