Healthcare Provider Details

I. General information

NPI: 1164585741
Provider Name (Legal Business Name): JULIE L SCHUMPELT ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PASEO DEL CANON E
TAOS NM
87571-6239
US

IV. Provider business mailing address

4 LAVENDER LN
RANCHOS DE TAOS NM
87557-8771
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-5223
  • Fax: 505-758-5298
Mailing address:
  • Phone: 505-751-1089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number225777
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: