Provider Demographics
NPI:1073026118
Name:COLLABORATIVE PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:COLLABORATIVE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-766-1179
Mailing Address - Street 1:3990 OLD TOWN AVE STE 106C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2968
Mailing Address - Country:US
Mailing Address - Phone:858-766-1179
Mailing Address - Fax:
Practice Address - Street 1:3990 OLD TOWN AVE STE 106C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2968
Practice Address - Country:US
Practice Address - Phone:858-766-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-12
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)