=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528393964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY HEALS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2009
-----------------------------------------------------
Last Update Date | 07/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23173 LA CADENA DR
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-837-2751
-----------------------------------------------------
Fax | 888-762-3708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23173 LA CADENA DR
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-837-2751
-----------------------------------------------------
Fax | 888-762-3708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | GINA TABRIZY
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 949-837-2751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MFC31490
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------