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General NPI Number Information
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NPI Number | 1578644159
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Entity Type | Organization
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Legal Business Name | MIND, BODY, SPIRIT COUNSELING
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 28570 MARGUERITE PKWY #L-2
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City | MISSION VIEJO
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State | CA
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Zip | 92692-3713
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Country | US
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Telephone | 949-370-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 23711 WHALE CV
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1666
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Country | US
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Telephone | 949-370-9442
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST II
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Name | DR. DESIREE DELAGARZA
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Credential | PSY.D.
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Telephone | 949-370-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 19575
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License Number State | CA
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