Healthcare Provider Details

I. General information

NPI: 1306621990
Provider Name (Legal Business Name): MCCORMICK PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18003 SKY PARK CIR STE H2
IRVINE CA
92614-6526
US

IV. Provider business mailing address

18003 SKY PARK CIR STE H2
IRVINE CA
92614-6526
US

V. Phone/Fax

Practice location:
  • Phone: 949-464-8272
  • Fax:
Mailing address:
  • Phone: 949-464-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TARA MCCORMICK
Title or Position: FOUNDER/CEO CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 949-228-7143