Provider Demographics
NPI:1720670334
Name:SCHANCK, DEBRA SUE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:SCHANCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28078 BAXTER RD STE 242
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1403
Mailing Address - Country:US
Mailing Address - Phone:951-290-6545
Mailing Address - Fax:951-290-6456
Practice Address - Street 1:28078 BAXTER RD STE 242
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1403
Practice Address - Country:US
Practice Address - Phone:951-290-6545
Practice Address - Fax:951-290-6456
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist