Provider Demographics
NPI:1770625212
Name:REDLANDS PSYCHOLOGICAL, INC.
Entity type:Organization
Organization Name:REDLANDS PSYCHOLOGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-793-8312
Mailing Address - Street 1:1210 NEVADA ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2895
Mailing Address - Country:US
Mailing Address - Phone:909-793-8312
Mailing Address - Fax:909-792-6507
Practice Address - Street 1:1210 NEVADA ST
Practice Address - Street 2:SUITE101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2895
Practice Address - Country:US
Practice Address - Phone:909-793-8312
Practice Address - Fax:909-792-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty