Healthcare Provider Details

I. General information

NPI: 1881311876
Provider Name (Legal Business Name): EMBRACE PSYCHOLOGICAL AND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18811 HUNTINGTON ST STE 200
HUNTINGTON BEACH CA
92648-6003
US

IV. Provider business mailing address

18811 HUNTINGTON ST STE 200
HUNTINGTON BEACH CA
92648-6003
US

V. Phone/Fax

Practice location:
  • Phone: 714-504-8840
  • Fax: 657-227-7201
Mailing address:
  • Phone: 714-504-8840
  • Fax: 657-227-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY G MADRIGAL
Title or Position: DIRECTOR CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 714-504-8840