Provider Demographics
NPI:1669241576
Name:ADOLESCENT MENTAL HEALTH LLC
Entity type:Organization
Organization Name:ADOLESCENT MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-239-9567
Mailing Address - Street 1:3400 IRVINE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3103
Mailing Address - Country:US
Mailing Address - Phone:949-836-6793
Mailing Address - Fax:
Practice Address - Street 1:23172 PLAZA POINTE DR STE 155
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-0101
Practice Address - Country:US
Practice Address - Phone:949-239-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health