Healthcare Provider Details

I. General information

NPI: 1801601091
Provider Name (Legal Business Name): DESERT THRIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SIERRA BLANCA
CEDAR CREST NM
87008-9445
US

IV. Provider business mailing address

36 SIERRA BLANCA
CEDAR CREST NM
87008-9445
US

V. Phone/Fax

Practice location:
  • Phone: 415-246-8530
  • Fax:
Mailing address:
  • Phone: 415-246-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY ALBONICO
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 415-246-8530