Provider Demographics
NPI:1649592379
Name:EATING DISORDER FOUNDATION OF ORANGE COUNTY
Entity Type:Organization
Organization Name:EATING DISORDER FOUNDATION OF ORANGE COUNTY
Other - Org Name:INSIGHT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRIMARY THERAPIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOURQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-285-9827
Mailing Address - Street 1:23232 PERALTA DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1443
Mailing Address - Country:US
Mailing Address - Phone:949-285-9827
Mailing Address - Fax:949-488-2418
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1443
Practice Address - Country:US
Practice Address - Phone:949-285-9827
Practice Address - Fax:949-488-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty