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General NPI Number Information
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NPI Number | 1508276056
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Entity Type | Organization
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Legal Business Name | BLUE TIGER RECOVERY INC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 73555 ALESSANDRO DR
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City | PALM DESERT
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State | CA
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Zip | 92260-3635
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Country | US
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Telephone | 760-534-3487
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Fax | 442-334-7901
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Provider Business Mailing Address
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Address Line | PO BOX 14252
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City | PALM DESERT
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State | CA
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Zip | 92255-4252
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Country | US
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Telephone | 760-534-3487
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Fax | 442-334-7901
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Authorized Official
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Title or Position | CEO
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Name | MR. TERRY L GATEWOOD
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Credential | L.C.S.W.
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Telephone | 323-217-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29305
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License Number State | CA
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