=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316570005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARITY CALIFORNIA PSYCHOLOGICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2020
-----------------------------------------------------
Last Update Date | 02/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27281 LAS RAMBLAS STE 200
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-617-0252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 PISTORIA LN
-----------------------------------------------------
City | LADERA RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92694-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-617-0252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COLLEEN LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-617-0252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------