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623 E Latham Ave Hemet CA 92543-4342 | |
| (951) 928-6326 | |
| (951) 344-8353 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 623 E Latham Ave, Hemet, California |
| Authorized Official Name and Position | Wolfgang Angelus Klebel (CEO) |
| Authorized Official Contact | 9519286326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
41580 Avenida Barca Temecula CA 92591-1561 Ph: (951) 623-9358 | 623 E Latham Ave Hemet CA 92543-4342 Ph: (951) 928-6326 |
| NPI Number | 1407369317 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407369317 | NPI | - | NPPES |
| 33-BEHS | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY6005 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
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