Healthcare Provider Details

I. General information

NPI: 1003111337
Provider Name (Legal Business Name): JONATHAN MORIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 714-953-4455
  • Fax: 714-542-2793
Mailing address:
  • Phone: 714-953-4455
  • Fax: 714-542-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30027
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number76736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: