Healthcare Provider Details

I. General information

NPI: 1942928015
Provider Name (Legal Business Name): THE MENTAL HEALTH COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 KINGS RD
NEWPORT BEACH CA
92663-5004
US

IV. Provider business mailing address

20377 SW ACACIA ST STE 110
NEWPORT BEACH CA
92660-0781
US

V. Phone/Fax

Practice location:
  • Phone: 888-717-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IAN ROY
Title or Position: BILLING DIRECTOR
Credential:
Phone: 949-446-6288