Basic Information
| Provider Information | |||||||||
| NPI: | 1922299049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VON KAENEL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ERIK | ||||||||
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| Credential: | CADC, RASI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77777 COUNTRY CLUB DR APT 219 | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922110464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607724354 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1330 N INDIAN CANYON DR STE A | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603229065 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 08/05/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RI-V0707231304 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.