Healthcare Provider Details

I. General information

NPI: 1265211908
Provider Name (Legal Business Name): GRIT PSYCHOLOGICAL SOLUTIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 10/27/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 E CHERRY HILL CT
ONTARIO CA
91761
US

IV. Provider business mailing address

2910 S ARCHIBALD AVE. SUITE A, #139
ONTARIO CA
91761-7358
US

V. Phone/Fax

Practice location:
  • Phone: 909-438-8392
  • Fax:
Mailing address:
  • Phone: 909-438-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON NICOLE WALKER
Title or Position: OWNER
Credential: PSY.D
Phone: 909-438-8392