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General NPI Number Information
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NPI Number | 1265169502
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Entity Type | Organization
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Legal Business Name | THE THOUGHT SHOPPE
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 7412 JOSHUA LN
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3747
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Country | US
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Telephone | 714-458-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 7412 JOSHUA LN
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3747
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Country | US
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Telephone | 714-458-5121
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CANDICE AMBER PACKARD
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Credential | LMFT 125086
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Telephone | 657-339-2252
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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 |
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License Number State |
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