Healthcare Provider Details

I. General information

NPI: 1740300128
Provider Name (Legal Business Name): CHILD GUIDANCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 245&205
BUENA PARK CA
90621-2840
US

IV. Provider business mailing address

6301 BEACH BLVD SUITE 245
BUENA PARK CA
90621-2840
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax: 714-736-0895
Mailing address:
  • Phone: 714-736-0231
  • Fax: 714-736-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number910-1912-5
License Number StateCA

VIII. Authorized Official

Name: MISS LORI PACK
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 714-953-4455