Healthcare Provider Details

I. General information

NPI: 1497397509
Provider Name (Legal Business Name): DAPHNE RAE PRIDDY LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 S STATE ST STE B
SAN JACINTO CA
92583-4922
US

IV. Provider business mailing address

300 S HIGHLAND SPRINGS AVE
BANNING CA
92220-6504
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3596
  • Fax:
Mailing address:
  • Phone: 951-755-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: