Provider Demographics
NPI:1528472321
Name:SCHROM, JOHN PATRICK (MS,, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:SCHROM
Suffix:
Gender:M
Credentials:MS,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NIGHTHAWK RD
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-5441
Mailing Address - Country:US
Mailing Address - Phone:208-267-6569
Mailing Address - Fax:208-267-6288
Practice Address - Street 1:222 NIGHTHAWK RD
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-5441
Practice Address - Country:US
Practice Address - Phone:208-267-6569
Practice Address - Fax:208-267-6288
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 3542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional