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General NPI Number Information
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NPI Number | 1730847286
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Entity Type | Organization
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Legal Business Name | PARK FAMILY THERAPY & ASSOCIATES, A CALIFORNIA MFT CORP
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 19712 MACARTHUR BLVD STE 110
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City | IRVINE
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State | CA
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Zip | 92612-2407
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Country | US
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Telephone | 949-891-5336
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Fax |
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Provider Business Mailing Address
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Address Line | 5319 UNIVERSITY DR STE 457
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City | IRVINE
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State | CA
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Zip | 92612-2965
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | JENNIFER PARK
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Credential |
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Telephone | 949-891-5336
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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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