Provider Demographics
NPI:1871333112
Name:OC COUPLE AND FAMILY THERAPY
Entity type:Organization
Organization Name:OC COUPLE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-769-0153
Mailing Address - Street 1:101 S EL CAMINO REAL STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5504
Mailing Address - Country:US
Mailing Address - Phone:949-769-0153
Mailing Address - Fax:
Practice Address - Street 1:101 S EL CAMINO REAL STE 106
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5504
Practice Address - Country:US
Practice Address - Phone:949-769-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health