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General NPI Number Information
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NPI Number | 1073093555
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Entity Type | Organization
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Legal Business Name | HESTIA INDIVIDUAL COUPLES AND FAMILY COUNSELING PROFESSIONAL CORPORATI
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 73929 LARREA ST STE 1B
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-883-0953
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Fax |
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Provider Business Mailing Address
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Address Line | 73929 LARREA ST STE 1B
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City | PALM DESERT
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State | CA
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Zip | 92260-4305
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Country | US
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Telephone | 760-883-0953
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | TERRI COMPTON
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Credential | LMFT
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Telephone | 760-883-0953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC96150
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License Number State | CA
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