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General NPI Number Information
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NPI Number | 1871480566
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Entity Type | Organization
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Legal Business Name | COACHELLA VALLEY LIGHTHOUSE
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 78900 AVENUE 47 STE 105
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City | LA QUINTA
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State | CA
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Zip | 92253-2070
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Country | US
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Telephone | 760-625-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 157 GARFIELD ST APT 4
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City | ASHLAND
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State | OR
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Zip | 97520-2251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED BEHAVIOR TECHNICIAN
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Name | ANNA PIERCE
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Credential |
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Telephone | 541-505-2810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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