| Collective Therapy Group | |
|
22792 Centre Dr Ste 104 Lake Forest CA 92630-6311 | |
| (714) 326-3722 | |
| Not Available |
| Full Name | Collective Therapy Group |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 22792 Centre Dr Ste 104, Lake Forest, California |
| Authorized Official Name and Position | Chandra Medina (OWNER) |
| Authorized Official Contact | 7143263722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collective Therapy Group 22792 Centre Dr Ste 104 Lake Forest CA 92630-6311 Ph: (714) 326-3722 | Collective Therapy Group 22792 Centre Dr Ste 104 Lake Forest CA 92630-6311 Ph: (714) 326-3722 |
| NPI Number | 1912687708 |
|---|---|
| Provider Enumeration Date | 07/18/2023 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912687708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
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