Basic Information
| Provider Information | |||||||||
| NPI: | 1063078350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE NEST COUNSELING AND PSYCHOLOGICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 481 | ||||||||
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| City: | SUN CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925860481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052845337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27403 YNEZ RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925914616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052845337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | RUIZ-SHANK | ||||||||
| AuthorizedOfficialFirstName: | MARTHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8052845337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.