Individual provider Active NPI

John M Schuderer, LISAC LPC

  • Professional Counselor
  • Prescott, AZ
National Provider Identifier
1174584957
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC10607 Issued in AZ
Practice address
642 Dameron Dr
West Yavapai Guidance Clinic Inc Hillside CD
Prescott, AZ 86301-2411
Phone
(928) 445-5211
Fax
(928) 776-8484
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LISAC11381 AZ
Professional Counselor 101YP2500X LPC10607 AZ Primary

Addresses

Primary practice location

642 Dameron Dr
West Yavapai Guidance Clinic Inc Hillside CD
Prescott, AZ 86301-2411

Mailing address

642 Dameron Dr
Prescott, AZ 86301-2411
Phone (928) 445-5211

Other identifiers 1

IdentifierTypeStateIssuer
739485MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LISAC11381AZMDAddiction (Substance Use Disorder) Counselor
LPC10607AZMDProfessional Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174584957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 DAMERON DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012411",
            "telephone_number": "928-445-5211",
            "fax_number": "928-776-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 DAMERON DR",
            "address_2": "WEST YAVAPAI GUIDANCE CLINIC INC HILLSIDE CD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012411",
            "telephone_number": "928-445-5211",
            "fax_number": "928-776-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUDERER",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "LISAC LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC11381",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC10607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "739485",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.