Basic Information
| Provider Information | |||||||||
| NPI: | 1578815460 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PALM SPRINGS UNIFIED SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 S FARRELL DR | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604161360 | ||||||||
| FaxNumber: | 7604161362 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S FARRELL DR | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604161360 | ||||||||
| FaxNumber: | 7604161362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 02/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | EVOSEVICH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7604161360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | MFC33118 | CA | Y | Agencies | Local Education Agency (LEA) |
No ID Information.