Provider Demographics
NPI:1740372440
Name:SCHOEDER, CHRYSTAL D (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRYSTAL
Middle Name:D
Last Name:SCHOEDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CHRYSTAL
Other - Middle Name:D
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N US HIGHWAY 89
Mailing Address - Street 2:NORTHERN ARIZONA VA HCS
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:859-948-7158
Mailing Address - Fax:928-776-6125
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:NORTHERN ARIZONA VA HCS (NAVAHCS)
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:859-948-7158
Practice Address - Fax:928-776-6125
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2005-80103TC1900X
KY1459103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling