Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2-0747 | TX |
N | 103T00000X | Psychologist | 2-0747 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2-0747 | TX |
N | 103TA0700X | Adult Development & Aging Psychologist | 2-0747 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2-0747 | TX |
Y | 103G00000X | Clinical Psychologist | 2-0747 | TX |
Y | 103TC0700X | Clinical Psychologist | 2-0747 | TX |
N | 103TC1900X | Counseling Psychologist | 2-0747 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2-0747 | TX |
N | 103TF0000X | Family Psychologist | 2-0747 | TX |
N | 103TF0200X | Forensic Psychologist | 2-0747 | TX |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2-0747 | TX |
N | 103TP2701X | Group Psychotherapist | 2-0747 | TX |
N | 103TS0200X | School Psychologist | 6558 | TX |
NPI | 1053461616 |
---|---|
Provider Name | Betty Lou Schroeder |
First Address | San Antonio, TX 78209-5701 |
Second Address | San Antonio, TX 78209-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 02/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032973201 | (05) | TX |
176220900 | WORKERS COMP (01) | TX |
74183432778209000 | TRICARE (01) | TX |
OOEF85 | BLUE CROSS BLUE SHEILD (01) | TX |