Organization
CHILDREN'S HOSPITAL OF ORANGE COUNTY
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
Legal business name
CHILDREN'S HOSPITAL OF ORANGE COUNTY
Authorized official
MARK KELLY (DIRECTOR, REVENUE CYCLE SUPPORT)
(714) 509-7861
Entity
Organization
Contact information
Practice address
170 S MAIN ST, ORANGE, CA 92868-2801
(714) 288-7651
(714) 288-7379
Mailing address
1201 W LA VETA AVE, ORANGE, CA 92868-4203
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093102766
—
CA
Enumeration date
12/06/2019
Last updated
12/06/2019
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