=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891596797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVENING STAR COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 665 CAMINO DE LOS MARES STE 203A
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-363-3456
-----------------------------------------------------
Fax | 949-493-4622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25544 PASEO LA VIS
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-363-3456
-----------------------------------------------------
Fax | 949-493-4622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARY CHRISTIE
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 949-363-3456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------