Healthcare Provider Details

I. General information

NPI: 1396330668
Provider Name (Legal Business Name): PATRICIA HUBER, LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SEAL BEACH BLVD STE 360
SEAL BEACH CA
90740-2747
US

IV. Provider business mailing address

PO BOX 334
SEAL BEACH CA
90740-0334
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-6505
  • Fax:
Mailing address:
  • Phone: 714-754-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA HUBER
Title or Position: PRESIDENT
Credential: LCSW PPS
Phone: 714-754-6505