Provider Demographics
NPI:1225509417
Name:DESERT RAIN THERAPY, LLC
Entity Type:Organization
Organization Name:DESERT RAIN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-740-6101
Mailing Address - Street 1:1000 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1526
Mailing Address - Country:US
Mailing Address - Phone:575-740-6101
Mailing Address - Fax:
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-1526
Practice Address - Country:US
Practice Address - Phone:575-740-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty