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General NPI Number Information
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NPI Number | 1891700241
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Entity Type | Organization
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Legal Business Name | DESERT BEHAVIORAL HEALTH A FAMILY COUNSELING CORP
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 15982 QUANTICO RD STE E
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1382
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Country | US
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Telephone | 760-946-2070
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Fax | 760-946-1511
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Provider Business Mailing Address
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Address Line | 15982 QUANTICO RD STE E
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1382
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Country | US
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Telephone | 760-946-2070
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Fax | 760-946-1511
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NAOMI VIVIAN FATE
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Credential | MFT
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Telephone | 760-946-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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