Healthcare Provider Details

I. General information

NPI: 1003737149
Provider Name (Legal Business Name): MENTAL HEALTH FOR TEENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 TRADE ST STE 125
SAN DIEGO CA
92121-2399
US

IV. Provider business mailing address

1 SPECTRUM POINTE DR STE 230
LAKE FOREST CA
92630-2292
US

V. Phone/Fax

Practice location:
  • Phone: 714-813-6317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LEVI SWEET
Title or Position: MANAGER
Credential:
Phone: 714-813-6317