# ETHERA OC LLC

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

## Provider details

- **NPI number:** 1639816226
- **Authorized official:** MR. ISAAC KIM (OPERATIONS OFFICER)
- **Authorized official phone:** (714) 745-5584

## Contact information

- **Practice address:** 19712 MACARTHUR BLVD STE 110, IRVINE, CA 92612-2407
- **Practice address phone:** (714) 725-9897
- **Mailing address:** 19712 MACARTHUR BLVD STE 110, IRVINE, CA 92612-2407
- **Mailing address phone:** (714) 725-9897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 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