Healthcare Provider Details

I. General information

NPI: 1225399231
Provider Name (Legal Business Name): ASSESSMENT, CONSULTATION, COUNSELING AND EDUCATIONAL SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27268 VIA INDUSTRIA
TEMECULA CA
92590-3751
US

IV. Provider business mailing address

27268 VIA INDUSTRIA
TEMECULA CA
92590-3751
US

V. Phone/Fax

Practice location:
  • Phone: 951-265-6504
  • Fax:
Mailing address:
  • Phone: 951-265-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14458
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-6512
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL KITLOWSKI
Title or Position: CO OWNER
Credential: PHD
Phone: 951-265-6504