# NEWPORT BEACH TRAUMA THERAPY, INC

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

## Provider details

- **NPI number:** 1902488208
- **Authorized official:** SHAVVONNE WALLS (CEO)
- **Authorized official phone:** (714) 457-7157

## Contact information

- **Practice address:** 260 NEWPORT CENTER DR STE 206, NEWPORT BEACH, CA 92660-7520
- **Practice address phone:** (949) 545-8684
- **Mailing address:** 260 NEWPORT CENTER DR STE 206, NEWPORT BEACH, CA 92660-7520
- **Mailing address phone:** (949) 545-8684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2021
- **Last updated:** 08/12/2021