1770685224 NPI number — MRS. ELAINE INGHAM SCHOMAKER LCSW,LMFT

Table of content: MRS. ELAINE INGHAM SCHOMAKER LCSW,LMFT (NPI 1770685224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770685224 NPI number — MRS. ELAINE INGHAM SCHOMAKER LCSW,LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOMAKER
Provider First Name:
ELAINE
Provider Middle Name:
INGHAM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW,LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770685224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2665 HOLLY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93611-6504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-292-0701
Provider Business Mailing Address Fax Number:
559-448-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2665 HOLLY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-292-0701
Provider Business Practice Location Address Fax Number:
559-448-4950
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 12479 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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