MEDICARE: PAUL PARK LMFT

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	106H00000X	Marriage & Family Therapist	141218	CA

General Provider Information

NPI Number	:	1932616034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL PARK LMFT

Provider Business Mailing Address
First Line	:	18302 IRVINE BLVD STE 375
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3435
Country	:	US
Telephone Number	:	714-661-5390
Fax Number	:	714-661-5449

Provider Business Practice Location Address
First Line	:	18302 IRVINE BLVD STE 375
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3435
Country	:	US
Telephone Number	:	714-661-5390
Fax Number	:	714-661-5449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	04/28/2026

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