Healthcare Provider Details

I. General information

NPI: 1093610305
Provider Name (Legal Business Name): GRITTY PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81673 AVENIDA ALTURAS
INDIO CA
92203-7782
US

IV. Provider business mailing address

81673 AVENIDA ALTURAS
INDIO CA
92203-7782
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-4623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA ROTH
Title or Position: OWNER
Credential:
Phone: 949-300-4623