Provider Demographics
NPI:1598277469
Name:SO CAL PSYCHOLOGY SERVICES APC
Entity Type:Organization
Organization Name:SO CAL PSYCHOLOGY SERVICES APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:949-542-3874
Mailing Address - Street 1:34249 CAMINO CAPISTRANO STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1138
Mailing Address - Country:US
Mailing Address - Phone:949-542-3874
Mailing Address - Fax:949-484-7021
Practice Address - Street 1:34249 CAMINO CAPISTRANO STE 101
Practice Address - Street 2:
Practice Address - City:CAPO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1138
Practice Address - Country:US
Practice Address - Phone:949-542-3874
Practice Address - Fax:949-484-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty