Provider Demographics
NPI:1356925325
Name:DESERT RIVER PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:DESERT RIVER PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-472-8375
Mailing Address - Street 1:4781 E GETTYSBURG AVE #101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1814
Mailing Address - Country:US
Mailing Address - Phone:559-472-8375
Mailing Address - Fax:888-466-8290
Practice Address - Street 1:4781 E GETTYSBURG AVE #101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1814
Practice Address - Country:US
Practice Address - Phone:559-472-8375
Practice Address - Fax:888-466-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5593142Medicaid