Healthcare Provider Details
I. General information
NPI: 1689475378
Provider Name (Legal Business Name): NEW LIFE PSYCHOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/20/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
23046 AVENIDA DE LA CARLOTA STE 600
LAGUNA HILLS CA
92653-1537
US
IV. Provider business mailing address
39 COLONY WAY
LAGUNA HILLS CA
92656-4243
US
V. Phone/Fax
- Phone: 949-454-9016
- Fax:
- Phone: 949-454-9016
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DAVID
ADAMS
Title or Position: CEO
Credential: PSY.D.
Phone: 949-454-9016