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General NPI Number Information
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NPI Number | 1083876676
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE THERAPY PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 32605 TEMECULA PKWY SUITE #303
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City | TEMECULA
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State | CA
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Zip | 92592-6837
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Country | US
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Telephone | 760-443-1355
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Fax | 951-302-2534
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Provider Business Mailing Address
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Address Line | 32605 TEMECULA PKWY SUITE #303
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City | TEMECULA
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State | CA
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Zip | 92592-6837
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Country | US
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Telephone | 760-443-1355
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Fax | 951-302-2534
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | DR. GLORIA JEAN GHANEM-YBARRA
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Credential | PSYD
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Telephone | 760-443-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19964
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License Number State | CA
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