Provider Demographics
NPI:1538586318
Name:SCHNELLER, MARY JO (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JO
Last Name:SCHNELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-1501
Mailing Address - Country:US
Mailing Address - Phone:314-637-7443
Mailing Address - Fax:
Practice Address - Street 1:315 LEMAY FERRY RD
Practice Address - Street 2:SUITE 132
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-1501
Practice Address - Country:US
Practice Address - Phone:314-637-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSC9C08A101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral