Mental Health Substance Abuse Program

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

RW2331 Issued in CA

Legal business name

MENTAL HEALTH SUBSTANCE ABUSE PROGRAM

Practice address

83912 Avenue 45 Ste 9
Indio, CA 92201-3338

Phone

(760) 347-0754

Fax

(760) 347-8507

NPI assigned

Mar 24, 2009

Last updated

Mar 24, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Maryjo Loera, CCBADC/CAADAC

Title

Behavioral Health Specialist III

Phone

(760) 347-0754

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1568604452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83912 AVENUE 45 STE 9",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922013338",
            "telephone_number": "760-347-0754",
            "fax_number": "760-347-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83912 AVENUE 45 STE 9",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922013338",
            "telephone_number": "760-347-0754",
            "fax_number": "760-347-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH SUBSTANCE ABUSE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "LOERA",
        "authorized_official_first_name": "MARYJO",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH SPECIALIST III",
        "authorized_official_telephone_number": "760-347-0754",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCBADC/CAADAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "RW2331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Indio, CA
• Providers in Indio, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.