NPI Code Detail JSON Logo

1669717922 NPI number — REDLANDS PSYCHOLOGICAL SERVICES

NPI Number: 1669717922
Health Care Provider/Practitioner: REDLANDS PSYCHOLOGICAL SERVICES

Information about “1669717922” NPI (REDLANDS PSYCHOLOGICAL SERVICES) exists in 1669717922 in HTML format HTML  |  1669717922 in plain Text format TXT  |  1669717922 in PDF (Portable Document Format) PDF  |  1669717922 in an XML format XML  formats.

NPI Number : 1669717922 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669717922",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REDLANDS PSYCHOLOGICAL SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "104 E OLIVE AVE STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "REDLANDS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92373-5255",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-327-2735",
    "MailingAddressFaxNumber": "909-327-2735",
    "FirstLinePracticeLocationAddress": "104 E OLIVE AVE STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REDLANDS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92373-5255",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-327-2735",
    "PracticeLocationAddressFaxNumber": "909-327-2735",
    "EnumerationDate": "11/27/2012",
    "LastUpdateDate": "03/26/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "POTTS",
    "AuthorizedOfficialFirstName": "GLENN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/ PSYCHOLOGIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.DIV., PHD",
    "AuthorizedOfficialTelephoneNumber": "909-904-4462",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TP0814X",
          "TaxonomyName": "Psychoanalysis Psychologist",
          "LicenseNumber": "PSY 23630",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY 23630",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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