Healthcare Provider Details

I. General information

NPI: 1144989286
Provider Name (Legal Business Name): CHRISTINA NEILY ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57675 29 PALMS HWY STE 104
YUCCA VALLEY CA
92284-3099
US

IV. Provider business mailing address

57675 29 PALMS HWY STE 104
YUCCA VALLEY CA
92284-3099
US

V. Phone/Fax

Practice location:
  • Phone: 760-844-0298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: