NPIMap

Organization Active NPI

Socal Adolescent Wellness, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Lake Forest, CA
National Provider Identifier
1083230262
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SOCAL ADOLESCENT WELLNESS, INC.
Practice address
23072 Lake Center Dr Ste 214
Lake Forest, CA 92630-2899
Phone
(949) 467-4324
NPI assigned
Jun 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca M Harris
Title
Cfo
Phone
(949) 467-4324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

23072 Lake Center Dr Ste 214
Lake Forest, CA 92630-2899

Mailing address

16052 Beach Blvd Ste 135
Huntington Beach, CA 92647-3817
Phone (949) 467-4324

National Provider Directory

National Provider Directory
Tax ID family
Socal Adolescent Wellness Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23072 Lake Center Dr
Ste 214
Lake Forest, CA 92630
Phone (949) 309-2227

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1083230262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16052 BEACH BLVD STE 135",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473817",
            "telephone_number": "949-467-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23072 LAKE CENTER DR STE 214",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302899",
            "telephone_number": "949-467-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCAL ADOLESCENT WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-467-4324"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.