Provider Demographics
NPI:1942428180
Name:INLAND PSYCHOLOGICAL PROF.CORP.
Entity Type:Organization
Organization Name:INLAND PSYCHOLOGICAL PROF.CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:IRENA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-596-3577
Mailing Address - Street 1:12530 10TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1407 FOOTHILL BLVD # 61
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3451
Practice Address - Country:US
Practice Address - Phone:909-596-3577
Practice Address - Fax:909-593-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1375724Medicaid