MEDICARE: OC COUPLE AND FAMILY THERAPY

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1871333112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OC COUPLE AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	101 S EL CAMINO REAL STE 106
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-5504
Country	:	US
Telephone Number	:	949-769-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S EL CAMINO REAL STE 106
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-5504
Country	:	US
Telephone Number	:	949-769-0153
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KERREEN CHAU
Credential	:	MFT
Telephone Number	:	949-769-0153

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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Directions to “OC COUPLE AND FAMILY THERAPY ” Practice Location

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