Freedom Collective Therapy Group

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

FREEDOM COLLECTIVE THERAPY GROUP

Doing business as

Collective Therapy Group

Practice address

22792 Centre Dr Ste 104
Lake Forest, CA 92630-6311

Phone

(714) 326-3722

NPI assigned

Jul 18, 2023

Last updated

Jul 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chandra MedinaNPI 1316218852

Title

Owner

Phone

(714) 326-3722

Specialties & licenses 2

Addresses

Other names 1

• Collective Therapy Group Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chandra Medina

  • Mental Health Counselor
  • Sacramento, CA
  • NPI 1316218852
  NPD Authorized official

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1912687708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22792 CENTRE DR STE 104",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306311",
            "telephone_number": "714-326-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22792 CENTRE DR STE 104",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306311",
            "telephone_number": "714-326-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEDOM COLLECTIVE THERAPY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-326-3722"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collective Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collective Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guadalupe Fraga
• Chennell Fragoso
• Dzoara Franco Camacho
• Jenna Frazer, PT, DPT
• Jaime Freeborn, PPS
• Yuko Fujinoki
• Full Swing Physical Therapy
• Lucas Fuller
• Kaitlyn Furman
• G. Fazilat, Inc

• Mental Health Counselor in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.