Organization
CENTER FOR HUMAN POTENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORNA PHAM PSYD (COMPLIANCE OFFICER)
(949) 237-0893
Entity
Organization
Contact information
Practice address
3151 AIRWAY AVE STE P3, COSTA MESA, CA 92626-4626
(310) 422-6744
Mailing address
3151 AIRWAY AVE STE P3, COSTA MESA, CA 92626-4626
(310) 422-6744
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
07/21/2022
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