Provider Demographics
NPI:1700915410
Name:SIERRA PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SIERRA PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-966-5644
Mailing Address - Street 1:69930 HIGHWAY 111 STE 204A
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2853
Mailing Address - Country:US
Mailing Address - Phone:626-966-5644
Mailing Address - Fax:760-202-7599
Practice Address - Street 1:69930 HIGHWAY 111 STE 204A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2853
Practice Address - Country:US
Practice Address - Phone:626-966-5644
Practice Address - Fax:760-202-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty