Healthcare Provider Details

I. General information

NPI: 1013555291
Provider Name (Legal Business Name): ELEASHA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81800 DOCTOR CARREON BLVD STE B
INDIO CA
92201-5595
US

IV. Provider business mailing address

81800 DOCTOR CARREON BLVD STE B
INDIO CA
92201-5595
US

V. Phone/Fax

Practice location:
  • Phone: 760-647-7676
  • Fax: 760-347-0909
Mailing address:
  • Phone: 760-647-7676
  • Fax: 760-347-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: