Provider Demographics
NPI:1821583337
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:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-953-4455
Mailing Address - Street 1:525 CABRILLO PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5017
Mailing Address - Country:US
Mailing Address - Phone:714-953-4455
Mailing Address - Fax:714-547-8855
Practice Address - Street 1:3551 CAMINO MIRA COSTA
Practice Address - Street 2:SUITE T
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-272-4444
Practice Address - Fax:949-272-4445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD GUIDANCE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-27
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