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General NPI Number Information
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NPI Number | 1346585908
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY PSYCHOLOGICAL, INC.
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 23832 ROCKFIELD BLVD STE 130
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City | LAKE FOREST
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State | CA
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Zip | 92630-2860
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Country | US
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Telephone | 949-297-6680
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Fax | 949-861-6321
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Provider Business Mailing Address
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Address Line | 23832 ROCKFIELD BLVD STE 130
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City | LAKE FOREST
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State | CA
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Zip | 92630-2860
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Country | US
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Telephone | 949-297-6680
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Fax | 949-861-6321
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL PSYCHOLOGIST
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Name | DR. SUSAN JOY NOVAK
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Credential | PHD
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Telephone | 949-297-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | PSY22415
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY22415
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License Number State | CA
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