| Psychological And Substance Abuse Services, Inc | |
|
21250 Box Springs Rd Ste 201 Moreno Valley CA 92557-8712 | |
| (951) 335-5858 | |
| (951) 335-5870 |
| Full Name | Psychological And Substance Abuse Services, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 21250 Box Springs Rd Ste 201, Moreno Valley, California |
| Authorized Official Name and Position | Ta Tanisha Jones (LICENSED PSYCHOLOGIST, DIRECTOR) |
| Authorized Official Contact | 9515054234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological And Substance Abuse Services, Inc 6185 Magnolia Ave #224 Riverside CA 92506 Ph: () - | Psychological And Substance Abuse Services, Inc 21250 Box Springs Rd Ste 201 Moreno Valley CA 92557-8712 Ph: (951) 335-5858 |
| NPI Number | 1073074209 |
|---|---|
| Provider Enumeration Date | 03/29/2019 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/07/2023 |
| Medicare PECOS PAC ID | 8022359389 |
|---|---|
| Medicare Enrollment ID | O20190415000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073074209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ta Tanisha Jones |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184112179 PECOS PAC ID: 9931440294 Enrollment ID: I20190415000923 |
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