Healthcare Provider Details

I. General information

NPI: 1306789839
Provider Name (Legal Business Name): COLLABORATIVE PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 LEMON ST STE 500
RIVERSIDE CA
92501-3374
US

IV. Provider business mailing address

3880 LEMON ST STE 500
RIVERSIDE CA
92501-3374
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1488
  • Fax:
Mailing address:
  • Phone: 951-530-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE MICHELLE OLIVAS
Title or Position: INTERN
Credential:
Phone: 951-941-2141