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General NPI Number Information
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NPI Number | 1619295938
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Entity Type | Individual
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Provider Name | MARY BERST PHD, PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 07/08/2023
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Provider Practice Location Address
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Address Line | 61645 LIVING STONE DR
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City | LA QUINTA
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State | CA
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Zip | 92253-9394
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Country | US
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Telephone | 760-902-9296
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Fax | 760-406-5906
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Provider Business Mailing Address
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Address Line | 49950 JEFFERSON ST STE 130-156
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City | INDIO
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State | CA
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Zip | 92201-8813
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Country | US
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Telephone | 760-902-9296
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Fax | 760-406-5906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 32434
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY32434
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32434
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License Number State | CA
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