Basic Information
| Provider Information | |||||||||
| NPI: | 1912493115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | GEOFFREY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S CALLE EL SEGUNDO APT 36 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607975994 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1370 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925834933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517913350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2018 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
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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 | 101YA0400X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 20120600725100 | 05 | CA | MEDICAID |