Healthcare Provider Details

I. General information

NPI: 1124157854
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 S MAIN ST SUITE A & B, WIT COURT & CHOICES FSP
SANTA ANA CA
92707-3255
US

IV. Provider business mailing address

822 W TOWN AND COUNTRY RD WIT COURT & CHOICES FSP
ORANGE CA
92868-4712
US

V. Phone/Fax

Practice location:
  • Phone: 714-668-8498
  • Fax: 714-668-8499
Mailing address:
  • Phone: 714-547-7559
  • Fax: 714-543-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A THRASH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MFT
Phone: 714-547-7559