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General NPI Number Information
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NPI Number | 1821607771
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Entity Type | Organization
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Legal Business Name | TONYA OCTAVE, LCSW, PROF CORP
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 237 S LAKEVIEW AVE STE A
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City | PLACENTIA
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State | CA
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Zip | 92870-6756
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Country | US
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Telephone | 714-705-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 237 S LAKEVIEW AVE STE A
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City | PLACENTIA
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State | CA
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Zip | 92870-6756
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Country | US
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Telephone | 714-705-0418
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Fax |
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Authorized Official
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Title or Position | LCSW/ PROVIDER
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Name | TONYA OCTAVE
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Credential |
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Telephone | 310-387-8164
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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 |
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License Number State |
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