Provider Demographics
NPI:1336774470
Name:ACE INDIVIDUAL AND FAMILY THERAPY
Entity Type:Organization
Organization Name:ACE INDIVIDUAL AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-891-2760
Mailing Address - Street 1:PO BOX 11253
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-1253
Mailing Address - Country:US
Mailing Address - Phone:714-975-0134
Mailing Address - Fax:
Practice Address - Street 1:5000 BIRCH STREET
Practice Address - Street 2:WEST TOWER, SUITE 306
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2127
Practice Address - Country:US
Practice Address - Phone:949-891-2760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty