Provider Demographics
NPI:1902043631
Name:SHAHIN PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SHAHIN PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-225-0415
Mailing Address - Street 1:221 AVENIDA MELISENDA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3952
Mailing Address - Country:US
Mailing Address - Phone:909-860-2880
Mailing Address - Fax:909-860-2885
Practice Address - Street 1:1930 S BREA CANYON RD
Practice Address - Street 2:C265
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4009
Practice Address - Country:US
Practice Address - Phone:909-860-2880
Practice Address - Fax:909-860-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty