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General NPI Number Information
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NPI Number | 1528776945
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Entity Type | Organization
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Legal Business Name | SOUL IN MIND PSYCHOLOGICAL SERVICES, SBC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 26266 MERIDIAN ST
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City | HEMET
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State | CA
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Zip | 92544-6486
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Country | US
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Telephone | 657-217-1141
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Fax | 657-202-1898
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Provider Business Mailing Address
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Address Line | 26266 MERIDIAN ST
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City | HEMET
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State | CA
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Zip | 92544-6486
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Country | US
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Telephone | 657-217-1141
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Fax | 657-202-1898
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JENNIFER M. SANDOVAL
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Credential | PHD
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Telephone | 657-217-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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