Healthcare Provider Details

I. General information

NPI: 1649088998
Provider Name (Legal Business Name): BEST LIFE FAMILY THERAPISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30240 RANCHO VIEJO RD STE C
SAN JUAN CAPISTRANO CA
92675-1515
US

IV. Provider business mailing address

30240 RANCHO VIEJO RD STE C
SAN JUAN CAPISTRANO CA
92675-1515
US

V. Phone/Fax

Practice location:
  • Phone: 949-444-2570
  • Fax:
Mailing address:
  • Phone: 949-444-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL KLEM
Title or Position: PRESIDENT
Credential: LMFT
Phone: 949-436-1035