Healthcare Provider Details

I. General information

NPI: 1356881452
Provider Name (Legal Business Name): MICHAEL TRIPET LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43585 MONTEREY AVE STE 8
PALM DESERT CA
92260-9400
US

IV. Provider business mailing address

PO BOX 6753
LA QUINTA CA
92248-6753
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7720
  • Fax: 442-666-8363
Mailing address:
  • Phone: 760-777-7720
  • Fax: 442-666-8363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: