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General NPI Number Information
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NPI Number | 1992949754
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Entity Type | Organization
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Legal Business Name | REDLANDS THERAPY GROUP
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 222 E OLIVE AVE SUITE 7
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City | REDLANDS
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State | CA
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Zip | 92373-5268
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Country | US
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Telephone | 909-798-7711
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Fax | 909-798-5188
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Provider Business Mailing Address
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Address Line | 222 E OLIVE AVE SUITE 7
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City | REDLANDS
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State | CA
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Zip | 92373-5268
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Country | US
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Telephone | 909-798-7711
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Fax | 909-798-5188
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL H. SIECK
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Credential | PHD
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Telephone | 909-798-7711
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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 | PY7061
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License Number State | CA
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