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General NPI Number Information
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NPI Number | 1861548612
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Entity Type | Organization
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Legal Business Name | PALO VERDE THERAPY, INC.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 160 CHERRY AVE.
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City | AUBURN
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State | CA
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Zip | 95603
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Country | US
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Telephone | 530-906-2319
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Fax |
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Provider Business Mailing Address
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Address Line | 160 CHERRY AVE.
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City | AUBURN
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State | CA
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Zip | 95603
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Country | US
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Telephone | 530-906-2319
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/OWNER/PRESIDENT
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Name | MRS. PAMELA GASTON SHORE
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Credential | MFT
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Telephone | 530-905-2319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 00847-L
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0901
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License Number State | NV
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