Provider Demographics
NPI:1558656173
Name:THE PALAVRA TREE, INC
Entity Type:Organization
Organization Name:THE PALAVRA TREE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:619-263-7768
Mailing Address - Street 1:4001 EL CAJON BLVD
Mailing Address - Street 2:#206 & 207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1109
Mailing Address - Country:US
Mailing Address - Phone:619-280-2300
Mailing Address - Fax:619-280-2345
Practice Address - Street 1:4001 EL CAJON BLVD
Practice Address - Street 2:#206 & 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1109
Practice Address - Country:US
Practice Address - Phone:619-280-2300
Practice Address - Fax:619-280-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370102CN251B00000X
251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency