Healthcare Provider Details

I. General information

NPI: 1689592164
Provider Name (Legal Business Name): BUILDING BLOCKS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ATLANTIC AVE STE 250
LONG BEACH CA
90807-2218
US

IV. Provider business mailing address

52 CLIFFORD
IRVINE CA
92618-8866
US

V. Phone/Fax

Practice location:
  • Phone: 949-697-9335
  • Fax:
Mailing address:
  • Phone: 949-697-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TWILA CLARK
Title or Position: OWNER
Credential: PHD
Phone: 949-697-9335