Healthcare Provider Details

I. General information

NPI: 1649716770
Provider Name (Legal Business Name): COUNTY OF ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 404
ORANGE CA
92868-3504
US

IV. Provider business mailing address

405 W 5TH ST STE 212
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 714-645-8045
  • Fax: 714-645-8052
Mailing address:
  • Phone: 714-568-5614
  • Fax: 714-834-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY KATHLEEN SABET
Title or Position: CHIEF COMPLIANCE OFFICER
Credential: LCSW, CHC, CHPC
Phone: 714-581-7769