Provider Demographics
NPI:1912578709
Name:DESERT WOLF THERAPY PLLC
Entity Type:Organization
Organization Name:DESERT WOLF THERAPY PLLC
Other - Org Name:DESERT WOLF THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:AARRON
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:915-257-9484
Mailing Address - Street 1:2100 GEORGE DIETER DR # 961846
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3815
Mailing Address - Country:US
Mailing Address - Phone:915-257-9484
Mailing Address - Fax:
Practice Address - Street 1:4728 RAMON VEGA LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-1220
Practice Address - Country:US
Practice Address - Phone:915-257-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty