Provider Demographics
NPI:1225399231
Name:ASSESSMENT, CONSULTATION, COUNSELING AND EDUCATIONAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:ASSESSMENT, CONSULTATION, COUNSELING AND EDUCATIONAL SUPPORT SERVICES
Other - Org Name:A.C.C.E.S.S
Other - Org Type:Other Name
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-265-6504
Mailing Address - Street 1:27268 VIA INDUSTRIA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3751
Mailing Address - Country:US
Mailing Address - Phone:951-265-6504
Mailing Address - Fax:
Practice Address - Street 1:27268 VIA INDUSTRIA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3751
Practice Address - Country:US
Practice Address - Phone:951-265-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-6512103K00000X
CAPSY14458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty