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NPI Code Detail

MEDICARE: CHILD GUIDANCE CENTER, INC.

MEDICARE: CHILD GUIDANCE CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency910-1912-5CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1910-1912-5OTHERCASTATE ID

General Provider Information

NPI Number : 1033238944
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILD GUIDANCE CENTER, INC.
Provider Business Mailing Address
First Line : 600 W SANTA ANA BLVD STE 205
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4542
Country : US
Telephone Number : 714-953-4455
Fax Number : 714-547-8855
Provider Business Practice Location Address
First Line : 600 W SANTA ANA BLVD STE 600
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4552
Country : US
Telephone Number : 714-953-4455
Fax Number : 714-547-8855
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MISS LORI PACK
Credential : LCSW
Telephone Number : 714-953-4455
Provider Enumeration Date : 03/29/2007
Last Update Date : 08/21/2024

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Directions to “CHILD GUIDANCE CENTER, INC. ” Practice Location

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