SOUTH COUNTY PSYCHOLOGICAL, INC. (NPI# 1346585908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346585908 |
| Entity Type | Organization |
| Organization Name | SOUTH COUNTY PSYCHOLOGICAL, INC. |
| Other Organization Name | SUSAN J. NOVAK, PHD |
| Practice Address |
23832 Rockfield Blvd Ste 130 Lake Forest CA 92630-2860 |
| Practice Telephone | 9492976680 |
| Practice Fax Number | 9498616321 |
| Mailing Telephone | 9492976680 |
| Mailing Fax Number | 9498616321 |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2020-03-03 |
| Authorized Official Name | DR. SUSAN JOY NOVAK (PRESIDENT/CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 9492976680 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
PSY22415 | CA | Ambulatory Health Care Facilities |
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
PSY22415 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Susan J. Novak, PhD | Other Name - Individual/Organization |
| Street Address |
23832 ROCKFIELD BLVD STE 130 |
| City | LAKE FOREST |
| State | CA |
| Zip Code | 92630-2860 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790258382 | Anne H. Lee Individual Couples & Family Therapy, Inc | Community/Behavioral Health | 23832 Rockfield Blvd Ste 130, Lake Forest, CA 92630-2860 | 2019-01-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194370338 | Ashlee Nicole-morton Sourapas | Midwife | 22672 Lambert Street, Suite 611, Lake Forest, CA 92630 | 2019-08-05 |
| 1134784879 | Scott Mach Enterprises | Custodial Care Facility | 23235 Cavanaugh Road, Lake Forest, CA 92630 | 2019-05-08 |
| 1992368930 | James Daniel Ticorat | Pharmacist | 25051 Calle Arenal, Lake Forest, CA 92630 | 2019-04-16 |
| 1770058349 | Tara L Anderson | Physician Assistant | 22365 El Toro Rd Unit 310, Lake Forest, CA 92630 | 2018-10-10 |
| 1659846855 | Song W. Jung. Dds. Inc | Dentist | 23361 El Toro Rd, Ste 105, Lake Forest, CA 92630 | 2018-10-04 |
| 1326520867 | Katherine Marie Billings | Speech-Language Pathologist | 25454 Navajo, Lake Forest, CA 92630 | 2018-08-31 |
| 1205339611 | Orange County Physiotherapy Services, P.C. | Physical Therapist | 22821 Aspan St., #100, Lake Forest, CA 92630 | 2018-03-12 |
| 1295245587 | Tara Rasta | Chiropractor | 22672 Lambert St Suite 620, Olsen Chiropractic, Lake Forest, CA 92630 | 2017-10-02 |
| 1750800132 | Jessica Aguilar | Marriage & Family Therapist | 21153 Calle De Paseo, Lake Forest, CA 92630 | 2017-09-16 |
| 1275072589 | Anhtu Wu | Pharmacist | 23182 Vista Way, Lake Forest, CA 92630 | 2017-02-20 |
| Find all providers in zip 92630 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306459029 | Lisa Eaton Therapy and Coaching, A Licensed Clinical Social Worker Cor | Clinic/Center | 3014 Lupine, Lake Forest, CA 92630-8439 | 2020-08-24 |
| 1902102882 | Deborah Reed Md Sc | Clinic/Center | 1 Westminster Street, Suite 104, Lake Forest, IL 60045-2774 | 2011-02-10 |
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| 1760090062 | New Dawn Tms Psychiatry | Clinic/Center | 640 S San Vincente Blvd, Ste. 210, Los Angeles, CA 90048 | 2020-07-22 |
| Find all providers with the same taxonomy | ||||
| City | LAKE FOREST |
| Zip Code | 92630 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.