Provider Demographics
NPI:1497825251
Name:DIVERSIFIED COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:BERMUDEZ
Authorized Official - Last Name:EDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-667-1196
Mailing Address - Street 1:23177 LA CADENA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1428
Mailing Address - Country:US
Mailing Address - Phone:949-455-0744
Mailing Address - Fax:949-455-9822
Practice Address - Street 1:720 N VALLEY ST
Practice Address - Street 2:SUITE J
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3830
Practice Address - Country:US
Practice Address - Phone:714-758-9920
Practice Address - Fax:714-758-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty