Provider Demographics
NPI:1093173742
Name:WELLQOR PSYCHOLOGICAL SERVICES OF CALIFORNIA, PC
Entity Type:Organization
Organization Name:WELLQOR PSYCHOLOGICAL SERVICES OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-268-6600
Mailing Address - Street 1:135 PINELAWN RD STE 204N
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3133
Mailing Address - Country:US
Mailing Address - Phone:844-888-0355
Mailing Address - Fax:
Practice Address - Street 1:25060 HANCOCK AVE STE 103-483
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5930
Practice Address - Country:US
Practice Address - Phone:844-888-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty