Provider Demographics
NPI:1144524943
Name:INDIAN WELLS PSYCHIATRY & COUNSELING CENTER INC.
Entity type:Organization
Organization Name:INDIAN WELLS PSYCHIATRY & COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NANDI
Authorized Official - Last Name:CHENIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-340-2829
Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7128
Mailing Address - Country:US
Mailing Address - Phone:760-340-2829
Mailing Address - Fax:760-340-2846
Practice Address - Street 1:74785 US HIGHWAY 111
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7128
Practice Address - Country:US
Practice Address - Phone:760-340-2829
Practice Address - Fax:760-340-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51305106H00000X
CA20A73782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty