# CHILDREN'S HOSPITAL OF ORANGE COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILDREN'S HOSPITAL OF ORANGE COUNTY
- **Other names:** The Thompson Autism Center at CHOC Children's
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659918852
- **Legal business name:** CHILDREN'S HOSPITAL OF ORANGE COUNTY
- **Authorized official:** MARK KELLY (DIRECTOR, REVENUE CYCLE SUPPORT)
- **Authorized official phone:** (714) 509-7861

## Contact information

- **Practice address:** 170 S MAIN ST, ORANGE, CA 92868-2801
- **Practice address phone:** (714) 288-7651
- **Practice address fax:** (714) 288-7379
- **Mailing address:** 1201 W LA VETA AVE, ORANGE, CA 92868-4203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 106E00000X | Assistant Behavior Analyst | — | NULL | — |
| 106E00000X | Assistant Behavior Analyst | — | — | — |
| 2084N0402X | Neurology with Special Qualifications in Child Neurology Physician | — | NULL | — |
| 2084N0402X | Neurology with Special Qualifications in Child Neurology Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 12/06/2019
- **Last updated:** 12/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1093102766 | — | CA |