Healthcare Provider Details

I. General information

NPI: 1417878539
Provider Name (Legal Business Name): GRACE SHIELA GUSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST STE B
INDIO CA
92201-6950
US

IV. Provider business mailing address

73373 COUNTRY CLUB DR APT 1405
PALM DESERT CA
92260-8627
US

V. Phone/Fax

Practice location:
  • Phone: 614-332-6588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: