Provider Demographics
NPI:1225759673
Name:CITY OF THE HEART PSYCHOLOGICAL SERVICE, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CITY OF THE HEART PSYCHOLOGICAL SERVICE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:ANGELUS
Authorized Official - Last Name:KLEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-928-6326
Mailing Address - Street 1:41580 AVENIDA BARCA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1561
Mailing Address - Country:US
Mailing Address - Phone:951-623-9358
Mailing Address - Fax:
Practice Address - Street 1:1550 CHESHIRE DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3726
Practice Address - Country:US
Practice Address - Phone:951-623-9358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty