Provider Demographics
NPI:1649469966
Name:TEMECULA MENTAL HEALTH
Entity type:Organization
Organization Name:TEMECULA MENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-600-6355
Mailing Address - Street 1:26964 SAINT KITTS CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4004
Mailing Address - Country:US
Mailing Address - Phone:951-696-6868
Mailing Address - Fax:
Practice Address - Street 1:41002 COUNTY CENTER DR
Practice Address - Street 2:SUITE 320
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6027
Practice Address - Country:US
Practice Address - Phone:951-600-6355
Practice Address - Fax:951-600-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)