Provider Demographics
NPI:1871591487
Name:SCHAFFER, MARY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:SCHAFFER
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 1:3 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6331
Mailing Address - Country:US
Mailing Address - Phone:254-717-2952
Mailing Address - Fax:254-780-9185
Practice Address - Street 1:1711 E CENTEX EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9166
Practice Address - Country:US
Practice Address - Phone:254-718-2952
Practice Address - Fax:254-780-9185
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2401103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039050201Medicaid
TX81687POtherBCBS
TX039050201Medicaid
TX81687PMedicare ID - Type Unspecified