| Organization Name: | WILDOMAR PSYCHOTHERAPY CENTER, INC. |
| NPI Number: | 1215390315 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD DEAN MORGAN (PRESIDENT) |
| Mailing Address: | 33030 Mission Trail Wildomar |
| State: | CA US |
| Postal Code: | 925958423 |
| Phone Number: | 9512795905 |
| Fax Number: | 9512795905 |
| NPI Enumeration Date: | 04/05/2016 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | PSY12109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |