=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174945554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORANGE COUNTY HEALTH PSYCHOLOGISTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2014
-----------------------------------------------------
Last Update Date | 03/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 IRVINE CENTER DR SUITE 800
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-528-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7700 IRVINE CENTER DR SUITE 800
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-528-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KRISTIN KLEPPE
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 949-528-6300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY24845
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------