Provider Demographics
NPI:1487277257
Name:PALM DESERT PSYCHIATRY INC
Entity type:Organization
Organization Name:PALM DESERT PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-540-0279
Mailing Address - Street 1:536 CAMINO MERCADO
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1814
Mailing Address - Country:US
Mailing Address - Phone:805-540-0279
Mailing Address - Fax:
Practice Address - Street 1:74075 EL PASEO STE B1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4145
Practice Address - Country:US
Practice Address - Phone:805-540-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)