Provider Demographics
NPI:1003936311
Name:CHILD GUIDANCE CENTER, INC.
Entity Type:Organization
Organization Name:CHILD GUIDANCE CENTER, INC.
Other - Org Name:CYS CHILD GUIDANCE CENTER, INC. NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-953-4455
Mailing Address - Street 1:680 LANGSDORF DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3702
Mailing Address - Country:US
Mailing Address - Phone:714-871-9264
Mailing Address - Fax:714-871-5032
Practice Address - Street 1:680 LANGSDORF DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:714-871-9264
Practice Address - Fax:714-871-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910-1912-5251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA910-1912-5OtherSTATE ID