Provider Demographics
NPI:1104198092
Name:SCHAEFER, CHRISTINE RAE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RAE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RAE
Other - Last Name:LOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3824 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2853
Mailing Address - Country:US
Mailing Address - Phone:405-602-0835
Mailing Address - Fax:405-602-0936
Practice Address - Street 1:3824 N MERIDIAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2853
Practice Address - Country:US
Practice Address - Phone:405-602-0835
Practice Address - Fax:405-602-0936
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)