MEDICARE: KCE FAMILY THERAPY COUNSELING PROF INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073248597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KCE FAMILY THERAPY COUNSELING PROF INC.

Provider Business Mailing Address
First Line	:	39485 REGENCY WAY
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-7109
Country	:	US
Telephone Number	:	408-799-7893
Fax Number	:

Provider Business Practice Location Address
First Line	:	39485 REGENCY WAY
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-7109
Country	:	US
Telephone Number	:	408-799-7893
Fax Number	:

Authorized Official
Title or Position	:	LMFT/CLINICAL DIRECTOR
Name	:	MR. KIAVASH EBADAT
Credential	:
Telephone Number	:	408-799-7893

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	01/27/2025

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