Healthcare Provider Details

I. General information

NPI: 1063745982
Provider Name (Legal Business Name): CANYON ACRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGEWOOD AVE SUITE 300
ORANGE CA
92868-2051
US

IV. Provider business mailing address

1845 W ORANGEWOOD AVE SUITE 300
ORANGE CA
92868-2051
US

V. Phone/Fax

Practice location:
  • Phone: 714-383-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FELICIA MARTIN
Title or Position: VICE PRESIDENT PROGRAMS
Credential: LMFT
Phone: 714-383-9343