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Organization
ETHERA OC LLC
Active
Organization
ETHERA OC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISAAC KIM (OPERATIONS OFFICER)
(714) 745-5584
Entity
Organization
Contact information
Practice address
19712 MACARTHUR BLVD STE 110, IRVINE, CA 92612-2407
(714) 725-9897
Mailing address
19712 MACARTHUR BLVD STE 110, IRVINE, CA 92612-2407
(714) 725-9897
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
NULL
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
133N00000X
Nutritionist
—
NULL
133N00000X
Nutritionist
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
221700000X
Art Therapist
—
NULL
221700000X
Art Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/16/2022
Last updated
05/19/2023
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