Provider Demographics
NPI:1972664647
Name:SCHALLER, ADAM BLAKE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:BLAKE
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 INDEPENDENCE CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4909
Mailing Address - Country:US
Mailing Address - Phone:530-332-8102
Mailing Address - Fax:
Practice Address - Street 1:55 INDEPENDENCE CIR STE 104
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4909
Practice Address - Country:US
Practice Address - Phone:530-518-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA788251041C0700X, 1041C0700X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA336682Medicaid