Healthcare Provider Details

I. General information

NPI: 1821583337
Provider Name (Legal Business Name): CHILD GUIDANCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 CAMINO MIRA COSTA SUITE T
SAN CLEMENTE CA
92672
US

IV. Provider business mailing address

525 CABRILLO PARK DR STE 300
SANTA ANA CA
92701-5017
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-4444
  • Fax: 949-272-4445
Mailing address:
  • Phone: 714-953-4455
  • Fax: 714-547-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number910-1912-5
License Number StateCA

VIII. Authorized Official

Name: ELAINE OROURKE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 714-953-4455