MEDICARE: COUNTY OF ORANGE

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407993249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF ORANGE

Provider Business Mailing Address
First Line	:	405 W 5TH ST STE 212
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4522
Country	:	US
Telephone Number	:	714-568-5614
Fax Number	:	714-834-6595

Provider Business Practice Location Address
First Line	:	1920 W CORPORATE WAY
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5373
Country	:	US
Telephone Number	:	714-667-7610
Fax Number	:	714-667-7621

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	MRS. KELLY KATHLEEN SABET
Credential	:	LCSW, CHC, CHPC
Telephone Number	:	714-581-7769

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/06/2023

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Directions to “COUNTY OF ORANGE ” Practice Location

Language	Start Address	Practice Location

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