Provider Demographics
NPI:1912417775
Name:PSYCHOLOGY CONSULTING, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PSYCHOLOGY CONSULTING, PROFESSIONAL CORPORATION
Other - Org Name:EMBRASSE RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TWEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-645-6636
Mailing Address - Street 1:550 W VISTA WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5735
Mailing Address - Country:US
Mailing Address - Phone:760-295-8727
Mailing Address - Fax:
Practice Address - Street 1:550 W VISTA WAY STE 103
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5735
Practice Address - Country:US
Practice Address - Phone:760-295-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGY CONSULTING, PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-06
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAA1224882084P0802X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty