Provider Demographics
NPI:1336272947
Name:SCHMIDT, CHARLES G
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 READING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4327
Mailing Address - Country:US
Mailing Address - Phone:310-702-5571
Mailing Address - Fax:
Practice Address - Street 1:14515 HAMLIN STREET
Practice Address - Street 2:#200
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411
Practice Address - Country:US
Practice Address - Phone:818-373-4993
Practice Address - Fax:818-780-0617
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist