Provider Demographics
NPI:1073074209
Name:PSYCHOLOGICAL AND SUBSTANCE ABUSE SERVICES, INC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL AND SUBSTANCE ABUSE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TA TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:951-505-4234
Mailing Address - Street 1:6185 MAGNOLIA AVE
Mailing Address - Street 2:#224
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8712
Practice Address - Country:US
Practice Address - Phone:951-335-5858
Practice Address - Fax:951-335-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty