MEDICARE: JOO YOUNG OH AMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	101285	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	101285	CA

General Provider Information

NPI Number	:	1316507528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOO YOUNG OH AMFT

Provider Business Mailing Address
First Line	:	10529 SLATER AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4841
Country	:	US
Telephone Number	:	714-768-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	10529 SLATER AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4841
Country	:	US
Telephone Number	:	714-768-8589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	06/19/2019

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Directions to “ JOO YOUNG OH AMFT” Practice Location

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