Provider Demographics
NPI:1366864001
Name:THE WELL RED LION PSYCHOLOGY,P.C.
Entity Type:Organization
Organization Name:THE WELL RED LION PSYCHOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES-WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-341-3366
Mailing Address - Street 1:529 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9434
Mailing Address - Country:US
Mailing Address - Phone:717-246-6431
Mailing Address - Fax:
Practice Address - Street 1:30 E BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-1402
Practice Address - Country:US
Practice Address - Phone:717-244-1082
Practice Address - Fax:717-244-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty