=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659555902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2007
-----------------------------------------------------
Last Update Date | 12/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51800 HARRISON ST
-----------------------------------------------------
City | COACHELLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92236-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-398-8055
-----------------------------------------------------
Fax | 760-398-8766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73302 HIGHWAY 111
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-3904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-773-0669
-----------------------------------------------------
Fax | 760-773-0569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JERRY MEINTS
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 760-773-0669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MFT14133
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------