Provider Demographics
NPI:1003317801
Name:REDMON, CAROLINE (LMFT #101189)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:REDMON
Suffix:
Gender:F
Credentials:LMFT #101189
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E TAHQUITZ CANYON WAY STE B-117
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6788
Mailing Address - Country:US
Mailing Address - Phone:760-880-4334
Mailing Address - Fax:
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY STE B-117
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6788
Practice Address - Country:US
Practice Address - Phone:760-880-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101189101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health