Organization
EMBODIED SELF PSYCHOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA GOMEZ PSY.D. (CEO)
(619) 361-1207
Entity
Organization
Contact information
Practice address
29578 SERENITY LN, MURRIETA, CA 92563-5869
(619) 361-1207
(760) 452-5481
Mailing address
29578 SERENITY LN, MURRIETA, CA 92563-5869
(619) 361-1207
(760) 452-5481
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437787249
NPI1
—
Enumeration date
12/04/2023
Last updated
12/04/2023
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