Healthcare Provider Details

I. General information

NPI: 1003936311
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: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR SUITE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

680 LANGSDORF DR SUITE 200
FULLERTON CA
92831-3702
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax: 714-871-5032
Mailing address:
  • Phone: 714-871-9264
  • Fax: 714-871-5032

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