=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063135275
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONJA VAN CLIEF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2022
-----------------------------------------------------
Last Update Date | 10/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14320 PALM DR
-----------------------------------------------------
City | DESERT HOT SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92240-6874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-773-6767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14320 PALM DR
-----------------------------------------------------
City | DESERT HOT SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92240-6874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-773-6767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------