Provider Demographics
NPI:1306185707
Name:ASSESSMENT, CONSULTATION, COUNSELLING AND EDUCATIONAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:ASSESSMENT, CONSULTATION, COUNSELLING AND EDUCATIONAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:KITLOWSK
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
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:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty