Provider Demographics
NPI:1962729475
Name:FAMILY SERVICES OF THE DESERT
Entity type:Organization
Organization Name:FAMILY SERVICES OF THE DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-347-2398
Mailing Address - Street 1:81711 US HIGHWAY 111
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-9785
Mailing Address - Country:US
Mailing Address - Phone:760-347-2398
Mailing Address - Fax:
Practice Address - Street 1:1297 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1423
Practice Address - Country:US
Practice Address - Phone:760-921-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICES OF THE DESERT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty