Provider Demographics
NPI:1992040869
Name:SHAHIN PSYCHOLOGICAL SERVICES. INC.
Entity Type:Organization
Organization Name:SHAHIN PSYCHOLOGICAL SERVICES. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:B. JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-860-2880
Mailing Address - Street 1:1152 VIA VERDE
Mailing Address - Street 2:PMB 121
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4401
Mailing Address - Country:US
Mailing Address - Phone:909-860-2880
Mailing Address - Fax:909-860-2885
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:STE M
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
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:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty