Healthcare Provider Details

I. General information

NPI: 1033972773
Provider Name (Legal Business Name): AMBER RAE SHUPE ASSOCIATES DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N PALM CANYON DR
PALM SPRINGS CA
92262-1868
US

IV. Provider business mailing address

2500 N PALM CANYON DR
PALM SPRINGS CA
92262-1868
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-5602
  • Fax: 760-670-2734
Mailing address:
  • Phone: 760-424-5602
  • Fax: 760-670-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130960
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: