Ethan Abercrombie
Individual provider Active NPI Clinical Psychologist · La Quinta, CA
NPI 1245660281 · NPPES record last updated Aug 18, 2025
Key facts
- NPI
- 1245660281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 21994 (CA)
- Practice address
- 81634 Ricochet Way
La Quinta, CA 92253-9063 - Phone
- (760) 218-7717
- NPI assigned
- Nov 12, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1236 | NM | MD | Clinical Psychologist |
| 3951 | AZ | MD | Neurology Physical Therapist |
| 21994 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1236 | NM | |
| Clinical Psychologist | 103TC0700X | 3951 | AZ | |
| Clinical Psychologist | 103TC0700X | 21994 | CA | Yes |
Addresses
Primary practice location
81634 Ricochet Way
La Quinta, CA 92253-9063
Mailing address
81634 Ricochet Way
La Quinta, CA 92253-9063
Phone (760) 218-7717
Other providers in La Quinta, CA
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- Marianna Abrahamyan
- Rezner H Abubakar
- Yomi A Adeyemi
- Behtash Adibi
- Advanced Foot and Ankle Specialists, Inc.
All providers in La Quinta, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.