=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932910825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JONA LICENSED CLINICAL SOCIAL WORKER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2025
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 E LAMBERT RD STE 278C
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-4578
-----------------------------------------------------
Fax | 714-613-0816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 E LAMBERT RD STE 278C
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-4578
-----------------------------------------------------
Fax | 714-613-0816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | EUNA PARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-519-4578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------