| Socal Adolescent Wellness, Inc. | |
|
23072 Lake Center Dr Ste 214 Lake Forest CA 92630-2899 | |
| (949) 467-4324 | |
| Not Available |
| Full Name | Socal Adolescent Wellness, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 23072 Lake Center Dr Ste 214, Lake Forest, California |
| Authorized Official Name and Position | Rebecca M Harris (CFO) |
| Authorized Official Contact | 9494674324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Socal Adolescent Wellness, Inc. 16052 Beach Blvd Ste 135 Huntington Beach CA 92647-3817 Ph: (949) 467-4324 | Socal Adolescent Wellness, Inc. 23072 Lake Center Dr Ste 214 Lake Forest CA 92630-2899 Ph: (949) 467-4324 |
| NPI Number | 1083230262 |
|---|---|
| Provider Enumeration Date | 06/23/2020 |
| Last Update Date | 06/23/2020 |
| Certification Date | 06/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083230262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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