Healthcare Provider Details

I. General information

NPI: 1417618042
Provider Name (Legal Business Name): ACME PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE K205
COSTA MESA CA
92626-4636
US

IV. Provider business mailing address

3151 AIRWAY AVE STE K205
COSTA MESA CA
92626-4636
US

V. Phone/Fax

Practice location:
  • Phone: 949-345-5387
  • Fax:
Mailing address:
  • Phone: 949-345-5387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY CRAWSHAW PSY.D.
Title or Position: OWNER
Credential:
Phone: 949-345-5387