Provider Demographics
NPI:1205488533
Name:ARENA THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:ARENA THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-339-9981
Mailing Address - Street 1:45 ROLLINS PL
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4137
Mailing Address - Country:US
Mailing Address - Phone:949-339-9981
Mailing Address - Fax:
Practice Address - Street 1:2488 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5196
Practice Address - Country:US
Practice Address - Phone:949-339-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health