Healthcare Provider Details

I. General information

NPI: 1417726175
Provider Name (Legal Business Name): AGAPE COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79061 AVENUE 42 APT C
BERMUDA DUNES CA
92203-8188
US

IV. Provider business mailing address

79061 AVENUE 42 APT C
BERMUDA DUNES CA
92203-8188
US

V. Phone/Fax

Practice location:
  • Phone: 951-496-6314
  • Fax:
Mailing address:
  • Phone: 951-496-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL R TRIPET
Title or Position: OWNER
Credential:
Phone: 951-496-6314