Healthcare Provider Details

I. General information

NPI: 1033049440
Provider Name (Legal Business Name): SERENE COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 CHAMBERS RD # 111
TUSTIN CA
92780-6936
US

IV. Provider business mailing address

2522 CHAMBERS RD # 111
TUSTIN CA
92780-6936
US

V. Phone/Fax

Practice location:
  • Phone: 908-798-9780
  • Fax:
Mailing address:
  • Phone: 908-798-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL M THORBURN
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 908-798-9780