Healthcare Provider Details

I. General information

NPI: 1740131051
Provider Name (Legal Business Name): HEALING SANDS MARRIAGE, FAMILY, AND CHILD COUNSELING, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E LINDSEY DR
PALM SPRINGS CA
92262-2028
US

IV. Provider business mailing address

308 W STATE ST STE 3D
REDLANDS CA
92373-4653
US

V. Phone/Fax

Practice location:
  • Phone: 909-577-1124
  • Fax: 866-365-2227
Mailing address:
  • Phone: 909-577-1124
  • Fax: 866-365-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANDON EHTESHAMZADEH
Title or Position: MANAGEMENT SERVICE OFFICER
Credential:
Phone: 951-205-2949