Provider Demographics
NPI:1942855168
Name:PRATT, AARON D (CADC 2)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:D
Last Name:PRATT
Suffix:
Gender:M
Credentials:CADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-9290
Mailing Address - Country:US
Mailing Address - Phone:760-548-4032
Mailing Address - Fax:
Practice Address - Street 1:1910 S CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-9290
Practice Address - Country:US
Practice Address - Phone:760-548-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1336320119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XMedicaid