Provider Demographics
NPI:1295414332
Name:PRISM COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PRISM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:PRIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:951-755-1107
Mailing Address - Street 1:300 S. HIGHLAND SPRINGS STE 6C #140
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-755-1107
Mailing Address - Fax:909-393-3830
Practice Address - Street 1:1132 BEAUMONT AVE STE 106
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1819
Practice Address - Country:US
Practice Address - Phone:951-755-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty