Healthcare Provider Details

I. General information

NPI: 1104797398
Provider Name (Legal Business Name): PSYCHOLOGY PARTNERS A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27349 JEFFERSON AVE STE 111
TEMECULA CA
92590-5610
US

IV. Provider business mailing address

27349 JEFFERSON AVE STE 111
TEMECULA CA
92590-5610
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-4460
  • Fax: 833-229-2302
Mailing address:
  • Phone: 951-383-4460
  • Fax: 833-229-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN CROWE
Title or Position: COO
Credential: RN
Phone: 951-383-4460