Provider Demographics
NPI:1083876676
Name:COMPASSIONATE THERAPY PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:COMPASSIONATE THERAPY PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GHANEM-YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:760-443-1355
Mailing Address - Street 1:32605 TEMECULA PKWY
Mailing Address - Street 2:SUITE #303
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6837
Mailing Address - Country:US
Mailing Address - Phone:760-443-1355
Mailing Address - Fax:951-302-2534
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE #303
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:760-443-1355
Practice Address - Fax:951-302-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty