Provider Demographics
NPI:1730721358
Name:DESERT MARRIAGE FAMILY COUNSELING INC
Entity type:Organization
Organization Name:DESERT MARRIAGE FAMILY COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREGGREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-563-6623
Mailing Address - Street 1:PO BOX 6753
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6753
Mailing Address - Country:US
Mailing Address - Phone:760-777-7720
Mailing Address - Fax:760-452-8532
Practice Address - Street 1:43585 MONTEREY AVE STE 1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9398
Practice Address - Country:US
Practice Address - Phone:760-777-7720
Practice Address - Fax:760-452-8532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT MARRIAGE FAMILY COUNSELING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-15
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568899417OtherNPI