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General NPI Number Information
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NPI Number | 1548788144
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Entity Type | Organization
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Legal Business Name | VR BIOFEEDBACK FOCUSED PSYCHOTHERAPY P.C.
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Dates
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Enumeration Date | 09/03/2017
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Last Update Date | 09/03/2017
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Provider Practice Location Address
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Address Line | 30131 TOWN CENTER DR STE 292
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2086
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Country | US
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Telephone | 949-391-3849
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Fax |
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Provider Business Mailing Address
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Address Line | 21 S MONTILLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-6000
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Country | US
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Telephone | 949-391-3849
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HOLLY GRUPE
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Credential | LMFT
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Telephone | 949-391-3849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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