Provider Demographics
NPI:1851178651
Name:DESIERTO PSYCHOLOGICAL PLLC
Entity Type:Organization
Organization Name:DESIERTO PSYCHOLOGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-238-6440
Mailing Address - Street 1:1819 S DOBSON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5656
Mailing Address - Country:US
Mailing Address - Phone:480-238-6440
Mailing Address - Fax:
Practice Address - Street 1:1819 S DOBSON RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5656
Practice Address - Country:US
Practice Address - Phone:480-238-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty