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General NPI Number Information
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NPI Number | 1376803247
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Entity Type | Organization
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Legal Business Name | LA CHEIM SCHOOL
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 1413 F ST
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City | ANTIOCH
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State | CA
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Zip | 94509-2220
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Country | US
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Telephone | 925-777-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 F ST
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City | ANTIOCH
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State | CA
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Zip | 94509-2220
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Country | US
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Telephone | 925-777-1133
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. PAUL JURANOVICH
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Credential | MFT INTERN
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Telephone | 925-777-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149761
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License Number State | CA
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