Healthcare Provider Details

I. General information

NPI: 1972048767
Provider Name (Legal Business Name): DARCY AVILES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78000 FRED WARING DR STE 102
PALM DESERT CA
92211-9266
US

IV. Provider business mailing address

PO BOX 12062
PALM DESERT CA
92255-2062
US

V. Phone/Fax

Practice location:
  • Phone: 760-308-2600
  • Fax: 760-772-1515
Mailing address:
  • Phone: 760-308-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3559
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: