Provider Demographics
NPI:1164585741
Name:SCHUMPELT, JULIE L (EDS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:L
Last Name:SCHUMPELT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-8771
Mailing Address - Country:US
Mailing Address - Phone:505-751-1089
Mailing Address - Fax:
Practice Address - Street 1:213 PASEO DEL CANON E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6239
Practice Address - Country:US
Practice Address - Phone:505-758-5223
Practice Address - Fax:505-758-5298
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225777103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47954353Medicaid