Healthcare Provider Details

I. General information

NPI: 1417875790
Provider Name (Legal Business Name): MR. JAMES BRIAN CLANCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E KATELLA AVE STE H
ORANGE CA
92867-5094
US

IV. Provider business mailing address

1500 E KATELLA AVE STE H
ORANGE CA
92867-5094
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-9400
  • Fax: 714-771-2980
Mailing address:
  • Phone: 714-639-9400
  • Fax: 714-771-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: