Healthcare Provider Details

I. General information

NPI: 1245154756
Provider Name (Legal Business Name): ORANGE COUNTY COUNSELING LICENSED CLINICAL SOCIAL WORKER PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15991 RED HILL AVE STE 101
TUSTIN CA
92780-7320
US

IV. Provider business mailing address

13681 NEWPORT AVE STE 8614
TUSTIN CA
92780-4689
US

V. Phone/Fax

Practice location:
  • Phone: 657-695-1938
  • Fax:
Mailing address:
  • Phone: 657-695-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAHANA HAM
Title or Position: CEO
Credential: LCSW
Phone: 657-695-1938