Provider Demographics
NPI:1093122608
Name:HELMER, JOHN ROBERT-CLYDE (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT-CLYDE
Last Name:HELMER
Suffix:
Gender:M
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 JACKSON DR STE 220-C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6002
Mailing Address - Country:US
Mailing Address - Phone:619-439-8479
Mailing Address - Fax:
Practice Address - Street 1:5360 JACKSON DR STE 220-C
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-438-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW613131041C0700X
CAPSY28837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14262172OtherCAQH