Organization
MENTAL HEALTH SUBSTANCE ABUSE PROGRAM
Active
Organization
MENTAL HEALTH SUBSTANCE ABUSE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYJO LOERA CCBADC/CAADAC (BEHAVIORAL HEALTH SPECIALIST III)
(760) 347-0754
Entity
Organization
Contact information
Practice address
83912 AVENUE 45 STE 9, INDIO, CA 92201-3338
(760) 347-0754
(760) 347-8507
Mailing address
83912 AVENUE 45 STE 9, INDIO, CA 92201-3338
(760) 347-0754
(760) 347-8507
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
RW2331
CA
Other
Enumeration date
03/24/2009
Last updated
03/24/2009
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