Healthcare Provider Details

I. General information

NPI: 1003631235
Provider Name (Legal Business Name): ORANGE COUNTY MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 IRVINE AVE STE 110
NEWPORT BEACH CA
92660-3102
US

IV. Provider business mailing address

3400 IRVINE AVE STE 110
NEWPORT BEACH CA
92660-3102
US

V. Phone/Fax

Practice location:
  • Phone: 201-306-5670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE GOMES
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 201-306-5670