# CHILD AND ADOLESCENT BEHAVIORAL HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053835496
- **Authorized official:** DR. IRIS A RICHARDSON PH.D. (PARTNER)
- **Authorized official phone:** (714) 696-1385

## Contact information

- **Practice address:** 17772 IRVINE BLVD STE 103, TUSTIN, CA 92780
- **Practice address phone:** (714) 696-1385
- **Practice address fax:** (888) 972-4028
- **Mailing address:** 17772 IRVINE BLVD, STE 103, TUSTIN, CA 92780-3256
- **Mailing address phone:** (714) 696-1385
- **Mailing address fax:** (888) 972-4028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |
| 103TH0100X | Health Service Psychologist | — | NULL | — |
| 103TH0100X | Health Service Psychologist | — | — | — |

## Other

- **Enumeration date:** 07/27/2017
- **Last updated:** 09/10/2024