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General NPI Number Information
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NPI Number | 1871097303
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Entity Type | Organization
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Legal Business Name | ATENCIO / MACLEAN SERVICES, INC.
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 30250 RANCHO VIEJO RD STE G
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1562
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Country | US
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Telephone | 949-444-6741
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Fax |
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Provider Business Mailing Address
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Address Line | 30250 RANCHO VIEJO RD STE G
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1562
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Country | US
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Telephone | 949-444-6741
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. GINA LOUISE ATENCIO-MACLEAN
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Credential | PSYD
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Telephone | 949-444-6741
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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 | PSY28555
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License Number State | CA
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