Provider Demographics
NPI:1962638890
Name:THE TEMECULA CENTER OF PASTORAL COUNSELING
Entity Type:Organization
Organization Name:THE TEMECULA CENTER OF PASTORAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, EDS
Authorized Official - Phone:951-240-5250
Mailing Address - Street 1:28545 FELIX VALDEZ AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-1859
Mailing Address - Country:US
Mailing Address - Phone:951-240-5250
Mailing Address - Fax:
Practice Address - Street 1:28545 FELIX VALDEZ AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1859
Practice Address - Country:US
Practice Address - Phone:951-240-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X, 101YP1600X, 101YP2500X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty