Basic Information
Provider Information
NPI: 1548527062
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDMOND
FirstName: HELEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 N ARROWHEAD AVE
Address2:  
City: SAN BERNARDINO
State: CA
PostalCode: 924011164
CountryCode: US
TelephoneNumber: 9099635355
FaxNumber:  
Practice Location
Address1: 5870 ARLINGTON AVE
Address2:  
City: RIVERSIDE
State: CA
PostalCode: 925042037
CountryCode: US
TelephoneNumber: 9516836596
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2012
LastUpdateDate: 10/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X107739CAY Behavioral Health & Social Service ProvidersCounselorMental Health
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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