Organization
RIVERSIDE UNVERSITY BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THADDEUS A WICKI MFT (SUPERVISOR)
(951) 443-2200
Entity
Organization
Contact information
Practice address
1688 N PERRIS BLVD STE L6-11, PERRIS, CA 92571-4709
(951) 443-2200
(951) 443-2230
Mailing address
1688 N PERRIS BLVD STE L6-11, PERRIS, CA 92571-4709
(951) 443-2200
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
CA
Enumeration date
01/05/2018
Last updated
01/05/2018
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