Provider Demographics
NPI:1629386180
Name:KIENZLE, HELEN (PHD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:KIENZLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:MANVELIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:83814 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2817
Mailing Address - Country:US
Mailing Address - Phone:760-774-7753
Mailing Address - Fax:
Practice Address - Street 1:1080 N INDIAN CANYON DR STE 203
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4871
Practice Address - Country:US
Practice Address - Phone:760-320-8005
Practice Address - Fax:760-406-6057
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CAPSY31067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner