Healthcare Provider Details

I. General information

NPI: 1245435270
Provider Name (Legal Business Name): ORANGE COUNTY ASSOCIATION FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22471 ASPAN ST SUITE 103
LAKE FOREST CA
92630-1642
US

IV. Provider business mailing address

1971 E 4TH ST STE 130A
SANTA ANA CA
92705-3917
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-2715
  • Fax: 949-548-3583
Mailing address:
  • Phone: 714-547-7559
  • Fax: 714-543-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A THRASH
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 714-547-7559