Healthcare Provider Details

I. General information

NPI: 1578695466
Provider Name (Legal Business Name): COUNTY OF ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23046 AVENIDA DE LA CARLOTA STE 500
LAGUNA HILLS CA
92653-1575
US

IV. Provider business mailing address

405 W 5TH ST STE 212
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-6900
  • Fax:
Mailing address:
  • Phone: 714-568-5614
  • Fax: 714-834-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY KATHLEEN SABET
Title or Position: CHIEF COMPLIANCE OFFICER
Credential: LCSW, CHC, CHPC
Phone: 714-834-3154