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NPI Code Detail

MEDICARE: CARYN NICOLE CONGDON

MEDICARE: CARYN NICOLE CONGDON
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1831960483
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARYN NICOLE CONGDON
Provider Business Mailing Address
First Line : 7131 CUSTER WAY
Second Line :
City : STANTON
State : CA
Zip : 90680-2817
Country : US
Telephone Number : 714-277-9134
Fax Number :
Provider Business Practice Location Address
First Line : 1901 E 4TH ST STE 350
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3908
Country : US
Telephone Number : 949-396-4566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2024
Last Update Date : 01/12/2024

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Directions to “ CARYN NICOLE CONGDON ” Practice Location

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