Basic Information
| Provider Information | |||||||||
| NPI: | 1689995839 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ONTARIO-MONTCLAIR SCHOOL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ONTARIO-MONTCLAIR SCHOOL DISTRICT COUNSELING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 950 W D ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094186445 | ||||||||
| FaxNumber: | 9094592542 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 S BON VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917614408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099306793 | ||||||||
| FaxNumber: | 9099306798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAMMOND | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 9094186445 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ONTARIO-MONTCLAIR SCHOOL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | N | Agencies | Local Education Agency (LEA) | 251B00000X | N | Agencies | Case Management | 251S00000X | CA | N | Agencies | Community/Behavioral Health | 252Y00000X | CA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.