Basic Information
| Provider Information | |||||||||
| NPI: | 1891098281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMOND | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | MS, MFT, LEP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 E CANAL DR | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953803936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096686121 | ||||||||
| FaxNumber: | 2096561487 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 E CANAL DR | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953803936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094850197 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 12/07/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | LEP 1342 | CA | N | Behavioral Health & Social Service Providers | Psychologist | School | 106H00000X | MFC 20086 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.