Healthcare Provider Details

I. General information

NPI: 1184477093
Provider Name (Legal Business Name): ACORN INTEGRATIVE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E AMERIGE AVE STE 228
FULLERTON CA
92832-1920
US

IV. Provider business mailing address

112 E AMERIGE AVE STE 228
FULLERTON CA
92832-1920
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-6733
  • Fax:
Mailing address:
  • Phone: 562-231-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: EMILY P. CHEN
Title or Position: OWNER
Credential: PHD
Phone: 562-231-6733