Healthcare Provider Details

I. General information

NPI: 1003759598
Provider Name (Legal Business Name): YUCCA DESERT COUNSELING LICENSED CLINICAL SOCIAL WORKER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57490 29 PALMS HWY STE C
YUCCA VALLEY CA
92284-2963
US

IV. Provider business mailing address

PO BOX 894
YUCCA VALLEY CA
92286-0894
US

V. Phone/Fax

Practice location:
  • Phone: 909-480-6566
  • Fax:
Mailing address:
  • Phone: 909-480-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CANDICE CAVANAUGH
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 909-480-6566