Provider Demographics
NPI:1205561461
Name:SCHNEL, JACK H (EDD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:H
Last Name:SCHNEL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 BART EARLE WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3666
Mailing Address - Country:US
Mailing Address - Phone:310-377-5477
Mailing Address - Fax:310-377-7259
Practice Address - Street 1:734 BART EARLE WAY STE 203
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3666
Practice Address - Country:US
Practice Address - Phone:310-377-5477
Practice Address - Fax:310-377-7259
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical