Provider Demographics
NPI:1376803247
Name:LA CHEIM SCHOOL
Entity Type:Organization
Organization Name:LA CHEIM SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JURANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT INTERN
Authorized Official - Phone:925-777-1133
Mailing Address - Street 1:1413 F ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2220
Mailing Address - Country:US
Mailing Address - Phone:925-777-1133
Mailing Address - Fax:
Practice Address - Street 1:1413 F ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2220
Practice Address - Country:US
Practice Address - Phone:925-777-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149761251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health