Healthcare Provider Details

I. General information

NPI: 1285074195
Provider Name (Legal Business Name): MISTY ANNE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISTY ANNE DAY

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44550 VILLAGE CT STE 103
PALM DESERT CA
92260-3817
US

IV. Provider business mailing address

44550 VILLAGE CT STE 103
PALM DESERT CA
92260-3817
US

V. Phone/Fax

Practice location:
  • Phone: 951-396-1395
  • Fax:
Mailing address:
  • Phone: 951-396-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number82181
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: