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General NPI Number Information
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NPI Number | 1821583337
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Entity Type | Organization
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Legal Business Name | CHILD GUIDANCE CENTER, INC.
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 3551 CAMINO MIRA COSTA SUITE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672
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Country | US
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Telephone | 949-272-4444
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Fax | 949-272-4445
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Provider Business Mailing Address
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Address Line | 525 CABRILLO PARK DR STE 300
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City | SANTA ANA
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State | CA
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Zip | 92701-5017
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Country | US
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Telephone | 714-953-4455
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Fax | 714-547-8855
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ELAINE OROURKE
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Credential |
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Telephone | 714-953-4455
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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 | 910-1912-5
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License Number State | CA
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