MEDICARE: ALL DESERT WELLNESS CENTERS

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	106H00000X	Marriage & Family Therapist	MFC 40537	CA

General Provider Information

NPI Number	:	1225365562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL DESERT WELLNESS CENTERS

Provider Business Mailing Address
First Line	:	74-333 HIGHWAY 111
Second Line	:	SUITE 205
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4131
Country	:	US
Telephone Number	:	760-797-5151
Fax Number	:	760-862-9130

Provider Business Practice Location Address
First Line	:	74-333 HIGHWAY 111
Second Line	:	SUITE 205
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4131
Country	:	US
Telephone Number	:	760-797-5151
Fax Number	:	760-862-9130

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	MRS. JAMIE DAWN KIRKPATRICK
Credential	:	LMFT
Telephone Number	:	760-797-5151

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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