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General NPI Number Information
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NPI Number | 1295020402
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Entity Type | Organization
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Legal Business Name | YOUTH GUIDENCE CENTER
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 3030 N HESPERIAN ST
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City | SANTA ANA
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State | CA
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Zip | 92706-1151
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Country | US
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Telephone | 714-836-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 N HESPERIAN ST
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City | SANTA ANA
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State | CA
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Zip | 92706-1151
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Country | US
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Telephone | 714-836-2736
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Fax |
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Authorized Official
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Title or Position | INTERN SUPERVISOR
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Name | DR. MATTHEW LYNCH
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Credential | PHD
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Telephone | 714-836-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY 20127
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License Number State | CA
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