Provider Demographics
NPI:1245666791
Name:SCHAFER, DARRYL (CCDC III)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W 57TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2893
Mailing Address - Country:US
Mailing Address - Phone:605-323-8131
Mailing Address - Fax:605-274-1919
Practice Address - Street 1:1905 W 57TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2893
Practice Address - Country:US
Practice Address - Phone:605-323-8131
Practice Address - Fax:605-274-1919
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11031476101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)