Provider Demographics
NPI:1972704930
Name:PALOMAR FAMILY COUNSELING SERVICE, INC.
Entity Type:Organization
Organization Name:PALOMAR FAMILY COUNSELING SERVICE, INC.
Other - Org Name:FALLBROOK FULL SERVICE PARTNERSHIP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-741-2660
Mailing Address - Street 1:1002 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4605
Mailing Address - Country:US
Mailing Address - Phone:760-741-2660
Mailing Address - Fax:760-741-2647
Practice Address - Street 1:120 W HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2053
Practice Address - Country:US
Practice Address - Phone:760-731-3235
Practice Address - Fax:760-731-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37HBOtherMEDI-CAL PROVIDER NUMBER