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General NPI Number Information
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NPI Number | 1356113120
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Entity Type | Organization
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Legal Business Name | LOOKING GLASS THERAPY SOLUTIONS
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 14841 YORBA ST STE 209
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City | TUSTIN
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State | CA
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Zip | 92780-2946
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Country | US
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Telephone | 619-815-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 14841 YORBA ST STE 209
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City | TUSTIN
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State | CA
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Zip | 92780-2946
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Country | US
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Telephone | 619-245-3709
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGICAL DIRECTOR
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Name | DR. BRANDON M. MCQUEEN
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Credential | LMFT
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Telephone | 619-245-3709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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