Provider Demographics
NPI:1609919356
Name:MUPAS, ALLISON (MA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MUPAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:FALLICK-MUPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35909 RENOIR PL
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-4549
Mailing Address - Country:US
Mailing Address - Phone:760-223-5311
Mailing Address - Fax:
Practice Address - Street 1:71650 SAHARA RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4336
Practice Address - Country:US
Practice Address - Phone:760-223-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist