Healthcare Provider Details

I. General information

NPI: 1669231908
Provider Name (Legal Business Name): SOUL IN MIND PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26266 MERIDIAN ST
HEMET CA
92544-6486
US

IV. Provider business mailing address

26266 MERIDIAN ST
HEMET CA
92544-6486
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-0397
  • Fax: 951-795-4560
Mailing address:
  • Phone: 951-585-0397
  • Fax: 951-795-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER SANDOVAL
Title or Position: CEO
Credential: PHD
Phone: 857-217-1141