Healthcare Provider Details

I. General information

NPI: 1831975614
Provider Name (Legal Business Name): ORANGE COUNTY THERAPY, A LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 QUAIL ST
NEWPORT BEACH CA
92660-2730
US

IV. Provider business mailing address

1400 QUAIL ST
NEWPORT BEACH CA
92660-2730
US

V. Phone/Fax

Practice location:
  • Phone: 949-561-2438
  • Fax: 877-325-2562
Mailing address:
  • Phone: 949-561-2438
  • Fax: 877-325-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY MAYOT
Title or Position: CEO
Credential: LCSW
Phone: 949-561-2438