Provider Demographics
NPI:1225730435
Name:CALM IN THE WILDERNESS
Entity Type:Organization
Organization Name:CALM IN THE WILDERNESS
Other - Org Name:THE CALM IN THE WILDERNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/LMFT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-881-5559
Mailing Address - Street 1:PO BOX 731915
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0045
Mailing Address - Country:US
Mailing Address - Phone:760-881-5559
Mailing Address - Fax:442-255-1126
Practice Address - Street 1:14201 KENTWOOD BLVD STE 2
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2472
Practice Address - Country:US
Practice Address - Phone:442-348-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty