Provider Demographics
NPI:1750008751
Name:THE MALAMA COLLECTIVE
Entity type:Organization
Organization Name:THE MALAMA COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MFT
Authorized Official - Phone:562-858-6427
Mailing Address - Street 1:130 CENTENNIAL WAY STE D
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3751
Mailing Address - Country:US
Mailing Address - Phone:562-858-6427
Mailing Address - Fax:
Practice Address - Street 1:130 CENTENNIAL WAY STE A&D
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3751
Practice Address - Country:US
Practice Address - Phone:562-858-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)