Healthcare Provider Details

I. General information

NPI: 1073242541
Provider Name (Legal Business Name): JUSTIN MCARDLE AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR STE 100
LAGUNA HILLS CA
92653-1523
US

IV. Provider business mailing address

5722 E STILLWATER AVE UNIT 125
ORANGE CA
92869-3195
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-0888
  • Fax:
Mailing address:
  • Phone: 657-333-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: