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301 9th St Ste 100-173 Redlands CA 92374-4412 | |
| (909) 654-5992 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 301 9th St Ste 100-173, Redlands, California |
| Authorized Official Name and Position | Lance Johns (CEO) |
| Authorized Official Contact | 9512716356 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1255 W Colton Ave Redlands CA 92374-2861 Ph: (909) 654-5992 | 301 9th St Ste 100-173 Redlands CA 92374-4412 Ph: (909) 654-5992 |
| NPI Number | 1013516350 |
|---|---|
| Provider Enumeration Date | 10/19/2020 |
| Last Update Date | 04/04/2024 |
| Certification Date | 04/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013516350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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