Provider Demographics
NPI:1578644159
Name:MIND, BODY, SPIRIT COUNSELING
Entity Type:Organization
Organization Name:MIND, BODY, SPIRIT COUNSELING
Other - Org Name:DR. DESIREE DELAGARZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST II
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAGARZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-370-9442
Mailing Address - Street 1:23711 WHALE CV
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1666
Mailing Address - Country:US
Mailing Address - Phone:949-370-9442
Mailing Address - Fax:
Practice Address - Street 1:28570 MARGUERITE PKWY
Practice Address - Street 2:#L-2
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3713
Practice Address - Country:US
Practice Address - Phone:949-370-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19575261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health