Healthcare Provider Details

I. General information

NPI: 1982957114
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12755 BROOKHURST ST STE 116
GARDEN GROVE CA
92840-4855
US

IV. Provider business mailing address

12755 BROOKHURST ST STE 116
GARDEN GROVE CA
92840-4855
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-8277
  • Fax:
Mailing address:
  • Phone: 714-638-8277
  • 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: MISS KELLY HUYNH
Title or Position: REHAB SPECIALIST
Credential:
Phone: 714-360-8382