Healthcare Provider Details

I. General information

NPI: 1932826542
Provider Name (Legal Business Name): MARCUM PSYCHOLOGICAL SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30310 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1576
US

IV. Provider business mailing address

2884 EL RIO CIR
COSTA MESA CA
92626-4112
US

V. Phone/Fax

Practice location:
  • Phone: 949-427-5183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN MARCUM
Title or Position: FOUNDER
Credential: PSYD
Phone: 949-427-5183