Healthcare Provider Details

I. General information

NPI: 1033238944
Provider Name (Legal Business Name): CHILD GUIDANCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/21/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SANTA ANA BLVD STE 600
SANTA ANA CA
92701-4552
US

IV. Provider business mailing address

600 W SANTA ANA BLVD STE 205
SANTA ANA CA
92701-4542
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-4455
  • Fax: 714-547-8855
Mailing address:
  • Phone: 714-953-4455
  • Fax: 714-547-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number910-1912-5
License Number StateCA

VIII. Authorized Official

Name: MISS LORI PACK
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 714-953-4455