Provider Demographics
NPI:1083648752
Name:LUM, MARK STEPHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:LUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80736
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0736
Mailing Address - Country:US
Mailing Address - Phone:949-713-9846
Mailing Address - Fax:949-713-9846
Practice Address - Street 1:1801 E HEIM AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3020
Practice Address - Country:US
Practice Address - Phone:714-282-9713
Practice Address - Fax:714-282-8016
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical