Healthcare Provider Details

I. General information

NPI: 1891098281
Provider Name (Legal Business Name): JOHN MARK HAMMOND MS, MFT, LEP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E CANAL DR
TURLOCK CA
95380-3936
US

IV. Provider business mailing address

440 E CANAL DR
TURLOCK CA
95380-3936
US

V. Phone/Fax

Practice location:
  • Phone: 209-485-0197
  • Fax:
Mailing address:
  • Phone: 209-668-6121
  • Fax: 209-656-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP 1342
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 20086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: