Provider Demographics
NPI:1194549758
Name:CORAL VALLEY PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:CORAL VALLEY PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-382-4416
Mailing Address - Street 1:5010 E WARNER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3354
Mailing Address - Country:US
Mailing Address - Phone:480-382-4416
Mailing Address - Fax:
Practice Address - Street 1:5010 E WARNER RD STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3354
Practice Address - Country:US
Practice Address - Phone:480-382-4416
Practice Address - Fax:844-444-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty