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General NPI Number Information
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NPI Number | 1932505088
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Entity Type | Organization
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Legal Business Name | LORETTA MEAD PSYCHOLOGY INC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 5005 LA MART DR STE 100-B10
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City | RIVERSIDE
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State | CA
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Zip | 92507-5952
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Country | US
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Telephone | 909-242-5409
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Fax |
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Provider Business Mailing Address
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Address Line | 25930 YANEZ TRAIL RD
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City | MORENO VALLEY
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State | CA
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Zip | 92551-2101
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Country | US
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Telephone | 909-242-5409
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LORETTA MEAD
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Credential | PSYD
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Telephone | 909-242-5409
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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 | 24298
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License Number State | CA
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