Healthcare Provider Details

I. General information

NPI: 1952683245
Provider Name (Legal Business Name): THE GARY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E. 17TH STREET SUITE B
SANTA ANA CA
92705-8521
US

IV. Provider business mailing address

341 S. HILLCREST STREET
LA HABRA CA
90631-5394
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-0400
  • Fax: 714-542-0404
Mailing address:
  • Phone: 562-691-3263
  • Fax: 562-690-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. PAMELA DAWN AUSTIN
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, ACSW
Phone: 562-691-3263