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General NPI Number Information
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NPI Number | 1245055029
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Entity Type | Organization
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Legal Business Name | SIERRA PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 600 N MOUNTAIN AVE STE C205B
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City | UPLAND
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State | CA
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Zip | 91786-4315
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Country | US
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Telephone | 909-758-2175
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Fax |
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Provider Business Mailing Address
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Address Line | 154A W FOOTHILL BLVD # 421
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City | UPLAND
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State | CA
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Zip | 91786-3847
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Country | US
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Telephone | 909-758-2175
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIA MORENO
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Credential | EDD
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Telephone | 909-758-2175
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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 | 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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