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General NPI Number Information
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NPI Number | 1659748218
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Entity Type | Organization
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Legal Business Name | GAY &LESBIAN COMMUNITY SERVICES CENTER OF ORANGE COUNTY
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 1605 N SPURGEON ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2355
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Country | US
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Telephone | 714-953-5428
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Fax | 714-246-8907
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Provider Business Mailing Address
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Address Line | 1605 N SPURGEON ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2355
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Country | US
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Telephone | 714-953-5428
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Fax | 714-246-8907
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Authorized Official
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Title or Position | ASSOCIATE DIR/DIR OF MENTAL HEALTH
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Name | MS. ANN MARIE MASON
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Credential | LMFT
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Telephone | 714-953-5428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC37590
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License Number State | CA
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