Provider Demographics
NPI:1992949754
Name:REDLANDS THERAPY GROUP
Entity type:Organization
Organization Name:REDLANDS THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-798-7711
Mailing Address - Street 1:222 E OLIVE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5268
Mailing Address - Country:US
Mailing Address - Phone:909-798-7711
Mailing Address - Fax:909-798-5188
Practice Address - Street 1:222 E OLIVE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5268
Practice Address - Country:US
Practice Address - Phone:909-798-7711
Practice Address - Fax:909-798-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPY7061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty