| Triple Moon Psychotherapy Collective A Licensed Social Worker Corp | |
|
12371 Lewis St Ste 103 Garden Grove CA 92840-4687 | |
| (949) 868-8255 | |
| Not Available |
| Full Name | Triple Moon Psychotherapy Collective A Licensed Social Worker Corp |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12371 Lewis St Ste 103, Garden Grove, California |
| Authorized Official Name and Position | Amy Le Reve Renderos (DIRECTOR) |
| Authorized Official Contact | 9518701528 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Triple Moon Psychotherapy Collective A Licensed Social Worker Corp 12371 Lewis St Ste 103 Garden Grove CA 92840-4687 Ph: (951) 870-1528 | Triple Moon Psychotherapy Collective A Licensed Social Worker Corp 12371 Lewis St Ste 103 Garden Grove CA 92840-4687 Ph: (949) 868-8255 |
| NPI Number | 1306587837 |
|---|---|
| Provider Enumeration Date | 04/06/2022 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306587837 | NPI | - | NPPES |
| 100215178 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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