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Organization
CENTER FOR HUMAN POTENTIAL LLC
Active
Organization
CENTER FOR HUMAN POTENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORNA PHAM PSYD (COMPLIANCE OFFICER)
(949) 237-0893
Entity
Organization
Contact information
Practice address
3151 AIRWAY AVE STE P3, COSTA MESA, CA 92626-4626
(310) 422-6744
Mailing address
3151 AIRWAY AVE STE P3, COSTA MESA, CA 92626-4626
(310) 422-6744
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
07/21/2022
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