| Entrust Psychotherapy Inc. | |
|
3151 Airway Ave Ste K102 Costa Mesa CA 92626-4613 | |
| (714) 444-0395 | |
| (714) 444-0571 |
| Full Name | Entrust Psychotherapy Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3151 Airway Ave Ste K102, Costa Mesa, California |
| Authorized Official Name and Position | Susan L Thrasher (OWNER) |
| Authorized Official Contact | 7144440395 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Entrust Psychotherapy Inc. 3151 Airway Ave Ste K102 Costa Mesa CA 92626-4613 Ph: (714) 444-0395 | Entrust Psychotherapy Inc. 3151 Airway Ave Ste K102 Costa Mesa CA 92626-4613 Ph: (714) 444-0395 |
| NPI Number | 1144304486 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144304486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY11290 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | MFC39390 (California) | Primary |
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