Provider Demographics
NPI:1982737458
Name:LUSK PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:LUSK PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:SANDERS PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-626-5589
Mailing Address - Street 1:225 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6038
Mailing Address - Country:US
Mailing Address - Phone:909-626-5589
Mailing Address - Fax:909-217-7537
Practice Address - Street 1:225 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6038
Practice Address - Country:US
Practice Address - Phone:909-626-5589
Practice Address - Fax:909-217-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty