Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LEP3661 | CA |
N | 103T00000X | Psychologist | LEP3661 | CA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LEP3661 | CA |
N | 103TC1900X | Counseling Psychologist | LEP3661 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | LEP3661 | CA |
NPI | 1093236481 |
---|---|
Provider Name | Ms. Colette Diane Sinclair |
First Address | Redlands, CA 92373-4611 |
Second Address | Redlands, CA 92373-4611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |