Provider Demographics
NPI: | 1700267499 |
---|---|
Name: | RINCON-SCHLUTZ, JESSIE ESTHER (PSYD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JESSIE |
Middle Name: | ESTHER |
Last Name: | RINCON-SCHLUTZ |
Suffix: | |
Gender: | F |
Credentials: | PSYD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 902 S MYRTLE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MONROVIA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91016-3427 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11741 TELEGRAPH RD STE G |
Practice Address - Street 2: | |
Practice Address - City: | SANTA FE SPRINGS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90670-3687 |
Practice Address - Country: | US |
Practice Address - Phone: | 562-942-8256 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2015-06-18 |
Last Update Date: | 2019-12-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PSY31476 | 103T00000X |
225C00000X, 390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |