Provider Demographics
NPI:1033844576
Name:SULMEYER, JOHN (MFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SULMEYER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 PALOS VERDES DR N STE 212
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3726
Mailing Address - Country:US
Mailing Address - Phone:310-325-1151
Mailing Address - Fax:310-325-1151
Practice Address - Street 1:2075 PALOS VERDES DR N STE 212
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3726
Practice Address - Country:US
Practice Address - Phone:310-325-1151
Practice Address - Fax:310-325-1151
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist