Provider Demographics
NPI:1740059534
Name:RESCH, SAMMUEL KENNETH
Entity type:Individual
Prefix:
First Name:SAMMUEL
Middle Name:KENNETH
Last Name:RESCH
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 1:12215 TELEGRAPH RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3344
Mailing Address - Country:US
Mailing Address - Phone:562-252-8500
Mailing Address - Fax:
Practice Address - Street 1:12215 TELEGRAPH RD STE 111
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3344
Practice Address - Country:US
Practice Address - Phone:562-252-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician