Healthcare Provider Details

I. General information

NPI: 1992508915
Provider Name (Legal Business Name): AVIS SHERITA MCNEAL AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 MCLANE STREET STE B
PALM SPRINGS CA
92262
US

IV. Provider business mailing address

PO BOX 2651
PALM SPRINGS CA
92263-2651
US

V. Phone/Fax

Practice location:
  • Phone: 760-288-4579
  • Fax:
Mailing address:
  • Phone: 760-288-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT152896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: