Provider Demographics
NPI:1942246582
Name:GARY J. SCHUMMER, APC
Entity Type:Organization
Organization Name:GARY J. SCHUMMER, APC
Other - Org Name:ADD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:DU BRUYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-272-3870
Mailing Address - Street 1:27725 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6704
Mailing Address - Country:US
Mailing Address - Phone:949-272-3870
Mailing Address - Fax:949-951-2802
Practice Address - Street 1:27725 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6704
Practice Address - Country:US
Practice Address - Phone:949-272-3870
Practice Address - Fax:949-951-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 12832OtherCLINICAL PSYCH LICENSE
CAPSY 12832OtherCLINICAL PSYCH LICENSE
CAR16203Medicare UPIN