MEDICARE: THE MENTAL HEALTH COLLECTIVE, LLC

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
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1033837976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MENTAL HEALTH COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	20377 SW ACACIA ST STE 120
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-0781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2082 ORCHARD DRIVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660
Country	:	US
Telephone Number	:	888-717-9355
Fax Number	:

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	IAN ROY
Credential	:
Telephone Number	:	949-446-6288

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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