Provider Demographics
NPI:1457159089
Name:PAXWELL CHILD & FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:PAXWELL CHILD & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ATHALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-490-2819
Mailing Address - Street 1:17602 17TH ST STE 120-66
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27281 LAS RAMBLAS STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8303
Practice Address - Country:US
Practice Address - Phone:949-490-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty