=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386800282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFILIATED COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2008
-----------------------------------------------------
Last Update Date | 09/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16152 BEACH BLVD SUITE 280
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-848-5804
-----------------------------------------------------
Fax | 714-848-5184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16152 BEACH BLVD SUITE 280
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-848-5804
-----------------------------------------------------
Fax | 714-848-5184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ATTORNEY
-----------------------------------------------------
Name | MR. LAWRENCE A TREGLIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-848-5804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------