Healthcare Provider Details

I. General information

NPI: 1174212591
Provider Name (Legal Business Name): CALIFORNIA TREATMENT COLLECTIVE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CADILLAC AVE BLDG O SUITE 110
COSTA MESA CA
92626-1429
US

IV. Provider business mailing address

3505 CADILLAC AVE BLDG O SUITE 110
COSTA MESA CA
92626-1429
US

V. Phone/Fax

Practice location:
  • Phone: 949-832-6169
  • Fax:
Mailing address:
  • Phone: 949-832-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MCNAMARA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-832-6169