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NPI Code Detail

MEDICARE: ASSESSMENT, CONSULTATION, COUNSELLING AND EDUCATIONAL SUPPORT SERVICES

MEDICARE: ASSESSMENT, CONSULTATION, COUNSELLING AND EDUCATIONAL SUPPORT SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1306185707
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSESSMENT, CONSULTATION, COUNSELLING AND EDUCATIONAL SUPPORT SERVICES
Provider Business Mailing Address
First Line : 27268 VIA INDUSTRIA
Second Line :
City : TEMECULA
State : CA
Zip : 92590-3751
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 27268 VIA INDUSTRIA
Second Line :
City : TEMECULA
State : CA
Zip : 92590-3751
Country : US
Telephone Number : 951-265-6504
Fax Number :
Authorized Official
Title or Position : CO-DIRECTOR
Name : MICHAEL DEWITT KITLOWSK
Credential :
Telephone Number : 951-265-6504
Provider Enumeration Date : 02/05/2013
Last Update Date : 02/05/2013

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