Provider Demographics
NPI:1912493115
Name:SCHMIDT, ALAN GEOFFREY (MS)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:GEOFFREY
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E HOBSONWAY SPC 38
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-4123
Mailing Address - Country:US
Mailing Address - Phone:760-797-5994
Mailing Address - Fax:
Practice Address - Street 1:4200 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2742
Practice Address - Country:US
Practice Address - Phone:540-654-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6710101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20120600725100Medicaid