Provider Demographics
NPI:1891120184
Name:HI-DESERT BEHAVIORAL HEALTH CENTRE
Entity Type:Organization
Organization Name:HI-DESERT BEHAVIORAL HEALTH CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-366-1541
Mailing Address - Street 1:57407 29 PALMS HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57407 29 PALMS HWY
Practice Address - Street 2:SUITE F
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-366-1541
Practice Address - Fax:760-228-1614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HI-DESERT MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management