Provider Demographics
NPI:1992986616
Name:MARK LUM PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:MARK LUM PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-713-9846
Mailing Address - Street 1:1801 E HEIM AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3020
Mailing Address - Country:US
Mailing Address - Phone:714-282-9713
Mailing Address - Fax:714-282-8016
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty