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Organization
COACHELLA VALLEY LIGHTHOUSE
Active
Organization
COACHELLA VALLEY LIGHTHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE ROSALES BCBA (CEO/EXECUTIVE CLINICAL DIRECTOR)
(760) 625-0951
Entity
Organization
Contact information
Practice address
78900 AVENUE 47, SUITE 105, LA QUINTA, CA 92253-2070
(760) 625-0951
(760) 564-5049
Mailing address
PO BOX 355, INDIO, CA 92202-0355
(760) 625-0951
(760) 564-5049
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-10337
FL
103T00000X
Psychologist
LEP3111
CA
103TC1900X
Counseling Psychologist
LEP3111
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
LEP3111
CA
103TS0200X
School Psychologist
LEP3111
CA
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/05/2012
Last updated
05/18/2023
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