Provider Demographics
NPI:1154154060
Name:ACTUALIZE PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:ACTUALIZE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LEP
Authorized Official - Phone:760-265-2633
Mailing Address - Street 1:7707 CALLE CASINO
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1815
Mailing Address - Country:US
Mailing Address - Phone:909-736-2911
Mailing Address - Fax:
Practice Address - Street 1:7707 CALLE CASINO
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1815
Practice Address - Country:US
Practice Address - Phone:909-736-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine