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General NPI Number Information
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NPI Number | 1003324807
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Entity Type | Organization
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Legal Business Name | THE OPEN DOOR CENTER FOR INTEGRATIVE HEALING
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 540 N GOLDEN CIRCLE DR STE 312
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City | SANTA ANA
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State | CA
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Zip | 92705-3926
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Country | US
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Telephone | 714-393-1891
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Fax | 714-242-1830
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Provider Business Mailing Address
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Address Line | 540 N GOLDEN CIRCLE DR STE 312
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City | SANTA ANA
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State | CA
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Zip | 92705-3926
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Country | US
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Telephone | 714-393-1891
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Fax | 714-242-1830
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JUDY C BENVENUTO
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Credential | LMFT
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Telephone | 714-393-1891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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