Healthcare Provider Details

I. General information

NPI: 1811826209
Provider Name (Legal Business Name): NORTH STAR PSYCHOLOGICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 09/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 EAST 7TH ST SUITE 1C
UPLAND CA
91786
US

IV. Provider business mailing address

1968 S. COAST HIGHWAY, SUITE 1858
LAGUNA BEACH CA
92651
US

V. Phone/Fax

Practice location:
  • Phone: 909-233-0526
  • Fax:
Mailing address:
  • Phone: 416-455-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE ROBERT DAVID COOK
Title or Position: CLINICAL PSYCHOLOGIST/PRESIDENT
Credential: PH.D.
Phone: 416-455-6336