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General NPI Number Information
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NPI Number | 1093173742
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Entity Type | Organization
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Legal Business Name | WELLQOR PSYCHOLOGICAL SERVICES OF CALIFORNIA, PC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 25060 HANCOCK AVE STE 103-483
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City | MURRIETA
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State | CA
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Zip | 92562-5930
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Country | US
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Telephone | 844-888-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 135 PINELAWN RD STE 204N
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City | MELVILLE
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State | NY
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Zip | 11747-3133
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Country | US
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Telephone | 844-888-0355
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Fax |
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Authorized Official
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Title or Position | PHD
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Name | RAYMOND SHALLBETTER
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Credential | PHD
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Telephone | 718-268-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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