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General NPI Number Information
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NPI Number | 1992040869
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Entity Type | Organization
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Legal Business Name | SHAHIN PSYCHOLOGICAL SERVICES. INC.
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE STE M
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4171
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Country | US
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Telephone | 909-860-2880
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Fax | 909-860-2885
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Provider Business Mailing Address
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Address Line | 1152 VIA VERDE PMB 121
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City | SAN DIMAS
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State | CA
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Zip | 91773-4401
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Country | US
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Telephone | 909-860-2880
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Fax | 909-860-2885
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Authorized Official
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Title or Position | CEO
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Name | DR. B. JOHN SHAHIN
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Credential | PSY.D
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Telephone | 909-860-2880
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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 | PSY18852
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License Number State | CA
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