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Organization
KINTSUGI HEALTH
Active
Organization
KINTSUGI HEALTH
Active
Other names
Kintsugi Mind Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TATYANA ELLISON MD (MEDICAL DIRECTOR)
(949) 500-8833
Entity
Organization
Contact information
Practice address
24012 CALLE DE LA PLATA STE 430, LAGUNA HILLS, CA 92653-7623
(949) 500-8833
Mailing address
24012 CALLE DE LA PLATA STE 430, LAGUNA HILLS, CA 92653-7623
(949) 500-8833
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
163W00000X
Registered Nurse
—
—
171100000X
Acupuncturist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
225700000X
Massage Therapist
—
—
225X00000X
Occupational Therapist
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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