=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356981393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMS SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2020
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S HARBOR BLVD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-908-0028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1633 E 4TH ST STE 160
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-5176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-865-1769
-----------------------------------------------------
Fax | 714-364-0071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | LYNDA KOLYBA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 714-908-0028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------