Basic Information
| Provider Information | |||||||||
| NPI: | 1750450151 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILD GUIDANCE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 E 1ST ST | ||||||||
| Address2: | 406 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927016384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149534455 | ||||||||
| FaxNumber: | 7145589488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 E 1ST ST | ||||||||
| Address2: | 406 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927016384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149534455 | ||||||||
| FaxNumber: | 7145589488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HASSAN | ||||||||
| AuthorizedOfficialFirstName: | LA VONNE | ||||||||
| AuthorizedOfficialMiddleName: | KATHERYN | ||||||||
| AuthorizedOfficialTitleorPosition: | MARRIAGE FAMILY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7149534455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MFT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 34068 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.