Provider Demographics
NPI:1811901796
Name:JACK H SCHNEL EDD ABPP PC
Entity type:Organization
Organization Name:JACK H SCHNEL EDD ABPP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHNEL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:310-377-5477
Mailing Address - Street 1:734 SILVER SPUR ROAD
Mailing Address - Street 2:#203
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-377-5477
Mailing Address - Fax:310-377-7259
Practice Address - Street 1:734 SILVER SPUR ROAD
Practice Address - Street 2:#203
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274
Practice Address - Country:US
Practice Address - Phone:310-377-5477
Practice Address - Fax:310-377-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9595103T00000X
CA12935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty