Basic Information
| Provider Information | |||||||||
| NPI: | 1861058653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIERRA COUNSELING PSYCHOTHERAPY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SIERRA COUNSELING LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 S MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094998872 | ||||||||
| FaxNumber: | 9514794390 | ||||||||
| Practice Location | |||||||||
| Address1: | 2275 S MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094998872 | ||||||||
| FaxNumber: | 9512795222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2019 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | PHILOBOS | ||||||||
| AuthorizedOfficialFirstName: | RAFIK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9094998872 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.