Provider Demographics
NPI:1902276306
Name:BALLINGER, REBECCA ELISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELISE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD STE 234G
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-326-2562
Mailing Address - Fax:909-658-8734
Practice Address - Street 1:101 E REDLANDS BLVD STE 234G
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-326-2562
Practice Address - Fax:909-658-8734
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27166103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist