Inland Counseling Corporation | |
1255 W Colton Ave Ste 110 Redlands CA 92374-2861 | |
(909) 556-3939 | |
Not Available |
Full Name | Inland Counseling Corporation |
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Speciality | Psychologist |
Location | 1255 W Colton Ave Ste 110, Redlands, California |
Authorized Official Name and Position | Joseph P Revetto (OWNER/MANGER/PROVIDER) |
Authorized Official Contact | 9095563939 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Inland Counseling Corporation 1255 W Colton Ave Ste 110 Redlands CA 92374-2861 Ph: (909) 556-3939 | Inland Counseling Corporation 1255 W Colton Ave Ste 110 Redlands CA 92374-2861 Ph: (909) 556-3939 |
NPI Number | 1730589391 |
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Provider Enumeration Date | 09/01/2014 |
Last Update Date | 01/09/2020 |
Certification Date | 01/09/2020 |
Medicare PECOS PAC ID | 9638591704 |
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Medicare Enrollment ID | O20200617003194 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730589391 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103T00000X | Psychologist | PSY 16033 (California) | Primary |
Provider Name | Joseph Revetto |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1154453843 PECOS PAC ID: 8820037252 Enrollment ID: I20050426000803 |
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