Provider Demographics
| NPI: | 1659980290 |
|---|---|
| Name: | PACIFIC SOLSTICE INTEGRATIVE CLINIC |
| Entity type: | Organization |
| Organization Name: | PACIFIC SOLSTICE INTEGRATIVE CLINIC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BRITTEN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DEVEREUX |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LADAC |
| Authorized Official - Phone: | 949-200-7929 |
| Mailing Address - Street 1: | 26732 CROWN VALLEY PKWY STE 443 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MISSION VIEJO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92691-6375 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 949-200-7929 |
| Mailing Address - Fax: | 949-506-3716 |
| Practice Address - Street 1: | 26732 CROWN VALLEY PKWY STE 443 |
| Practice Address - Street 2: | |
| Practice Address - City: | MISSION VIEJO |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 92691-6375 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 949-200-7929 |
| Practice Address - Fax: | 949-506-3716 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-07-29 |
| Last Update Date: | 2024-03-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | Group - Multi-Specialty |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | |
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
