1760607519 NPI number — MISSION VIEJO COUNSELING

Table of content: (NPI 1760607519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760607519 NPI number — MISSION VIEJO COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION VIEJO COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760607519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23120 ALICIA PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92692-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-586-1703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23120 ALICIA PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92692-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-586-1703
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VIGIL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
NONE
Authorized Official Title or Position:
COUNSELOR
Authorized Official Telephone Number:
949-586-1703

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC19214 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1225050537 . This is a "PERSONAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com