Provider Demographics
NPI:1669416848
Name:SCHUMMER, GARY J (MDIV,PHD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:SCHUMMER
Suffix:
Gender:M
Credentials:MDIV,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:111
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6015
Mailing Address - Country:US
Mailing Address - Phone:310-378-0547
Mailing Address - Fax:310-378-0347
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:111
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-378-0547
Practice Address - Fax:310-378-0347
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11860Medicare ID - Type UnspecifiedCLINICAL PSYCOLOGIST