Healthcare Provider Details

I. General information

NPI: 1457242976
Provider Name (Legal Business Name): NICOLE ANN PRYTHERCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N PALM CANYON DR STE A4
PALM SPRINGS CA
92262-1866
US

IV. Provider business mailing address

2500 N PALM CANYON DR STE A4
PALM SPRINGS CA
92262-1866
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: