Healthcare Provider Details

I. General information

NPI: 1033631718
Provider Name (Legal Business Name): SOCO DBT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DOVE ST STE 215
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

1001 DOVE ST STE 215
NEWPORT BEACH CA
92660-2848
US

V. Phone/Fax

Practice location:
  • Phone: 949-524-1509
  • Fax:
Mailing address:
  • Phone: 949-524-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY WESTIN
Title or Position: OWNER
Credential: LMFT, CEDS
Phone: 949-524-1509