1780603696 NPI number — MR. CHARLES FREDERICK STOLZENBACH LMFT

Table of content: MR. CHARLES FREDERICK STOLZENBACH LMFT (NPI 1780603696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780603696 NPI number — MR. CHARLES FREDERICK STOLZENBACH LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLZENBACH
Provider First Name:
CHARLES
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

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:
1780603696
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:
1725 28TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-6919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-874-2409
Provider Business Mailing Address Fax Number:
916-874-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 28TH STREET
Provider Second Line Business Practice Location Address:
AMH3
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-6919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-874-2409
Provider Business Practice Location Address Fax Number:
916-874-1296
Provider Enumeration Date:
07/19/2006

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: 106H00000X , with the licence number:  MFT1825 , 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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