Healthcare Provider Details

I. General information

NPI: 1205561461
Provider Name (Legal Business Name): JACK H. SCHNEL ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 BART EARLE WAY STE 203
ROLLING HILLS ESTATES CA
90274-3666
US

IV. Provider business mailing address

734 BART EARLE WAY STE 203
ROLLING HILLS ESTATES CA
90274-3666
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-5477
  • Fax: 310-377-7259
Mailing address:
  • Phone: 310-377-5477
  • Fax: 310-377-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: