| Organization Name: | MIND WELL PSYCHOLOGICAL SERVICES, PC |
| NPI Number: | 1053740746 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LORI Q CHAIB (DIRECTOR) |
| Mailing Address: | 648 Avenue B Redondo Beach |
| State: | CA US |
| Postal Code: | 902774829 |
| Phone Number: | 7084666443 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2013 |
| NPI Last Update Date: | 11/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY25255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |