Healthcare Provider Details

I. General information

NPI: 1386862969
Provider Name (Legal Business Name): STEPHEN M PUMPHREY LICENSED CLINICAL SOCIAL WORKERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23201 MILL CREEK DR STE 220
LAGUNA HILLS CA
92653
US

IV. Provider business mailing address

23201 MILL CREEK DR STE 220
LAGUNA HILLS CA
92653-7905
US

V. Phone/Fax

Practice location:
  • Phone: 949-460-5323
  • Fax: 949-460-5322
Mailing address:
  • Phone: 949-460-5323
  • Fax: 949-460-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW12047
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE PUMPHREY
Title or Position: PRESIDENT
Credential: LCSW
Phone: 949-460-5323