Provider Demographics
NPI:1740300128
Name:CHILD GUIDANCE CENTER, INC.
Entity type:Organization
Organization Name:CHILD GUIDANCE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-953-4455
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-736-0231
Mailing Address - Fax:714-736-0895
Practice Address - Street 1:6301 BEACH BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2840
Practice Address - Country:US
Practice Address - Phone:714-736-0231
Practice Address - Fax:714-736-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910-1912-5251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA910-1912-5OtherSTATE ID