Provider Demographics
NPI:1437171543
Name:LOMI SCHOOL FOUNDATION
Entity Type:Organization
Organization Name:LOMI SCHOOL FOUNDATION
Other - Org Name:LOMI PSYCHOTHERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-579-0465
Mailing Address - Street 1:320 10TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5291
Mailing Address - Country:US
Mailing Address - Phone:707-579-0465
Mailing Address - Fax:707-579-0560
Practice Address - Street 1:320 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5291
Practice Address - Country:US
Practice Address - Phone:707-579-0465
Practice Address - Fax:707-579-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306494090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61-31568OtherUNITED HEALTHCARE SERVICE
CAZZZ280023ZMedicare ID - Type Unspecified