Provider Demographics
NPI:1376849257
Name:CENTRAL COUNSELING SERVICES
Entity Type:Organization
Organization Name:CENTRAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERALYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHOCKEY-POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-842-0365
Mailing Address - Street 1:3564 CENTRAL AVE.
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2705
Mailing Address - Country:US
Mailing Address - Phone:951-842-0365
Mailing Address - Fax:951-656-5554
Practice Address - Street 1:3564 CENTRAL AVE.
Practice Address - Street 2:SUITE 2D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2705
Practice Address - Country:US
Practice Address - Phone:951-842-0365
Practice Address - Fax:951-656-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty