Provider Demographics
NPI:1831475342
Name:PSYCHOTHERAPY PLUS
Entity Type:Organization
Organization Name:PSYCHOTHERAPY PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-475-1777
Mailing Address - Street 1:PO BOX 26027
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92406-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4414
Practice Address - Country:US
Practice Address - Phone:909-475-1777
Practice Address - Fax:888-821-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21951251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health