Healthcare Provider Details

I. General information

NPI: 1497307011
Provider Name (Legal Business Name): SAUNDRA LYNN MCCORMICK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST STE 300
ANAHEIM CA
92801-5514
US

IV. Provider business mailing address

19772 MACARTHUR BLVD STE 220
IRVINE CA
92612-2405
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone: 949-304-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: