1962570929 NPI number — MR. TOM CHENEY LMFT

Table of content: MR. TOM CHENEY LMFT (NPI 1962570929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962570929 NPI number — MR. TOM CHENEY LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENEY
Provider First Name:
TOM
Provider Middle Name:
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:
1962570929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1373 SPENCER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95125-1757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-874-5624
Provider Business Mailing Address Fax Number:
408-297-5064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S ABEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILPITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95035-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-934-5123
Provider Business Practice Location Address Fax Number:
408-957-5807
Provider Enumeration Date:
11/30/2006

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:  51045 , 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)

  • Identifier: 6334 . This is a "SANTA CLARA COUNTY ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".