Healthcare Provider Details

I. General information

NPI: 1245872571
Provider Name (Legal Business Name): HEAL AND THRIVE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22994 EL TORO RD # 120
LAKE FOREST CA
92630-4961
US

IV. Provider business mailing address

22994 EL TORO RD # 120
LAKE FOREST CA
92630-4961
US

V. Phone/Fax

Practice location:
  • Phone: 818-606-1357
  • Fax: 714-820-6794
Mailing address:
  • Phone: 818-606-1357
  • Fax: 714-820-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROOZ KHOSH
Title or Position: CEO
Credential:
Phone: 714-459-2214