Healthcare Provider Details

I. General information

NPI: 1750286787
Provider Name (Legal Business Name): SOUL HAVEN COUNSELING OC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W MAIN ST STE 200B
TUSTIN CA
92780-4360
US

IV. Provider business mailing address

145 W MAIN ST STE 200B
TUSTIN CA
92780-4360
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-7811
  • Fax:
Mailing address:
  • Phone: 714-485-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTEN JOHNSON
Title or Position: PRESIDENT, CEO
Credential: LPCC
Phone: 714-485-7811