MEDICARE: TOLTEC THERAPY SERVICES

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

General Provider Information

NPI Number	:	1801448428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOLTEC THERAPY SERVICES

Provider Business Mailing Address
First Line	:	73550 ALESSANDRO DR STE 200
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3613
Country	:	US
Telephone Number	:	760-834-9008
Fax Number	:	760-834-7041

Provider Business Practice Location Address
First Line	:	73550 ALESSANDRO DR STE 200
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3613
Country	:	US
Telephone Number	:	760-834-9008
Fax Number	:	760-834-7041

Authorized Official
Title or Position	:	OWNER
Name	:	HORTENCIA DIAZ
Credential	:	LMFT
Telephone Number	:	760-834-9008

Provider Enumeration Date	:	07/13/2019
Last Update Date	:	07/13/2019

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Directions to “TOLTEC THERAPY SERVICES ” Practice Location

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