Organization
MY TEEN MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIE GOMES (AUTHORIZED OFFICIAL)
(201) 306-5670
Entity
Organization
Contact information
Practice address
1101 STANDIFORD AVE STE A1, MODESTO, CA 95350-0981
(201) 306-5670
Mailing address
2915 RED HILL AVE STE A210C, COSTA MESA, CA 92626-7979
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/09/2025
Last updated
10/09/2025
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