Full Name | |
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Speciality | Community/behavioral Health |
Location | 350 Lake View, Tahoma, California |
Authorized Official Name and Position | Mallory P Hill (PRESIDENT/CEO) |
Authorized Official Contact | 9493713573 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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668 N Coast Hwy # 1112 Laguna Beach CA 92651-1513 Ph: (949) 371-3573 | 350 Lake View Tahoma CA 96142 Ph: (949) 371-3573 |
NPI Number | 1093238545 |
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Provider Enumeration Date | 07/17/2017 |
Last Update Date | 07/17/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093238545 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |