Provider Demographics
NPI:1982421640
Name:TRISHA CHURCH LICENSE PROFESSIONAL CLINICAL COUNSELOR
Entity type:Organization
Organization Name:TRISHA CHURCH LICENSE PROFESSIONAL CLINICAL COUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:949-230-3123
Mailing Address - Street 1:PO BOX 1514
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-1514
Mailing Address - Country:US
Mailing Address - Phone:949-230-3123
Mailing Address - Fax:
Practice Address - Street 1:330 PARK AVE STE 7
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2352
Practice Address - Country:US
Practice Address - Phone:949-230-3123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty