1265211908 NPI number — GRIT PSYCHOLOGICAL SOLUTIONS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265211908 NPI number — GRIT PSYCHOLOGICAL SOLUTIONS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRIT PSYCHOLOGICAL SOLUTIONS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265211908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 S ARCHIBALD AVE.
Provider Second Line Business Mailing Address:
SUITE A, #139
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-7358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-438-8392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 E CHERRY HILL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-438-8392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-438-8392

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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