The Open Table

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THE OPEN TABLE

Practice address

151 Kalmus Dr. BLDG C
Suite 100
Costa Mesa, CA 92626

Phone

(949) 274-9627

NPI assigned

Dec 12, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Heim, M.A., J.D.

Title

Director

Phone

(949) 274-9627

Specialties & licenses 7

Addresses

Locations

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1396383022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 E 4TH ST STE 120",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927015143",
            "telephone_number": "949-274-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 KALMUS DR. BLDG C",
            "address_2": "SUITE 100",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92626",
            "telephone_number": "949-274-9627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OPEN TABLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-12",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "HEIM",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "949-274-9627",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A., J.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.