Healthcare Provider Details

I. General information

NPI: 1730721358
Provider Name (Legal Business Name): DESERT MARRIAGE FAMILY COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43585 MONTEREY AVE STE 1
PALM DESERT CA
92260-9398
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: 760-452-8532
Mailing address:
  • Phone: 760-777-7720
  • Fax: 760-452-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGGREY HOMME
Title or Position: CFO
Credential:
Phone: 760-563-6623