Healthcare Provider Details

I. General information

NPI: 1003324807
Provider Name (Legal Business Name): THE OPEN DOOR CENTER FOR INTEGRATIVE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N GOLDEN CIRCLE DR STE 312
SANTA ANA CA
92705-3926
US

IV. Provider business mailing address

540 N GOLDEN CIRCLE DR STE 312
SANTA ANA CA
92705-3926
US

V. Phone/Fax

Practice location:
  • Phone: 714-393-1891
  • Fax: 714-242-1830
Mailing address:
  • Phone: 714-393-1891
  • Fax: 714-242-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JUDY C BENVENUTO
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 714-393-1891