Healthcare Provider Details

I. General information

NPI: 1447885272
Provider Name (Legal Business Name): MODERN PARENTING SOLUTIONS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NEVADA ST STE 103
REDLANDS CA
92374-2957
US

IV. Provider business mailing address

1030 NEVADA ST STE 103
REDLANDS CA
92374-2957
US

V. Phone/Fax

Practice location:
  • Phone: 909-326-2562
  • Fax: 909-658-8734
Mailing address:
  • Phone: 909-326-2562
  • Fax: 909-658-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA ELISE BALLINGER
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 909-326-2562