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General NPI Number Information
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NPI Number | 1558656173
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Entity Type | Organization
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Legal Business Name | THE PALAVRA TREE, INC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 4001 EL CAJON BLVD #206 & 207
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City | SAN DIEGO
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State | CA
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Zip | 92105-1109
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Country | US
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Telephone | 619-280-2300
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Fax | 619-280-2345
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Provider Business Mailing Address
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Address Line | 4001 EL CAJON BLVD #206 & 207
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City | SAN DIEGO
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State | CA
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Zip | 92105-1109
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Country | US
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Telephone | 619-280-2300
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Fax | 619-280-2345
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DENISE R REED
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Credential | B.S.
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Telephone | 619-263-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 370102CN
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License Number State | CA
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