Provider Demographics
NPI:1487422747
Name:BLANK PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:BLANK PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:951-595-7386
Mailing Address - Street 1:27403 YNEZ RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4616
Mailing Address - Country:US
Mailing Address - Phone:951-595-7386
Mailing Address - Fax:951-414-3770
Practice Address - Street 1:27403 YNEZ RD STE 205
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4616
Practice Address - Country:US
Practice Address - Phone:951-595-7386
Practice Address - Fax:951-414-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health