Provider Demographics
NPI:1245821743
Name:FOOTHILLS NEUROCARE, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:FOOTHILLS NEUROCARE, A PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-260-5468
Mailing Address - Street 1:1145 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5013
Mailing Address - Country:US
Mailing Address - Phone:909-394-1667
Mailing Address - Fax:909-575-4783
Practice Address - Street 1:1145 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5013
Practice Address - Country:US
Practice Address - Phone:909-394-1667
Practice Address - Fax:909-575-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty