Healthcare Provider Details

I. General information

NPI: 1265698708
Provider Name (Legal Business Name): VANESSA MARIE MCCREERY LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23161 MILL CREEK DR STE 230
LAGUNA HILLS CA
92653-7935
US

IV. Provider business mailing address

12141 BROOKHURST ST STE 201
GARDEN GROVE CA
92840-2865
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-5350
  • Fax: 949-221-6939
Mailing address:
  • Phone: 657-261-7140
  • Fax: 714-922-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT 18973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: