Healthcare Provider Details

I. General information

NPI: 1841101656
Provider Name (Legal Business Name): GROWTHWORKS PROFESSIONAL CLINICAL COUNSELOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23121 VERDUGO DR STE 204
LAGUNA HILLS CA
92653-1339
US

IV. Provider business mailing address

27068 LA PAZ RD # 712
ALISO VIEJO CA
92656-3041
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-2950
  • Fax:
Mailing address:
  • Phone: 949-424-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. BEVERLY ODEN
Title or Position: OWNER/CLINICIAN
Credential: LPCC
Phone: 949-828-7610