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General NPI Number Information
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NPI Number | 1205226891
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Entity Type | Organization
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Legal Business Name | ELAN ACADEMIES
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 3158 RED HILL AVE STE 150
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City | COSTA MESA
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State | CA
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Zip | 92626-3428
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Country | US
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Telephone | 714-966-2312
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Fax | 714-966-2317
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Provider Business Mailing Address
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Address Line | 3158 RED HILL AVE STE 150
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City | COSTA MESA
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State | CA
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Zip | 92626-3428
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Country | US
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Telephone | 714-966-2312
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Fax | 714-966-2317
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MIMA RANSOM
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Credential |
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Telephone | 714-966-2312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | PSY22346
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License Number State | CA
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