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General NPI Number Information
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NPI Number | 1366864001
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Entity Type | Organization
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Legal Business Name | THE WELL RED LION PSYCHOLOGY,P.C.
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 30 E BROADWAY
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City | RED LION
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State | PA
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Zip | 17356-1402
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Country | US
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Telephone | 717-244-1082
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Fax | 717-244-1064
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Provider Business Mailing Address
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Address Line | 529 CRESTWOOD DR
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City | RED LION
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State | PA
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Zip | 17356-9434
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Country | US
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Telephone | 717-246-6431
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID HAYNES-WELLER
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Credential | PSYD
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Telephone | 717-341-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017368
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License Number State | PA
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