INDIVIDUAL (NPI# 1881019123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881019123 |
| Entity Type | Organization |
| Organization Name | INDIVIDUAL |
| Other Organization Name | INDIVIDUAL |
| Practice Address |
12966 Euclid St Suite 280 Garden Grove CA 92840-5200 |
| Practice Telephone | 7148234770 |
| Practice Fax Number | 7148234777 |
| Mailing Telephone | 7148234770 |
| Mailing Fax Number | 7148234777 |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |
| Authorized Official Name | MISS MABEL VASQUEZ (INTERN) |
| Authorized Official Telephone | 6264286916 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| individual | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1356793509 | Individual | Clinic/Center | 3500 Timberwood Cir Apt 2137, Arlington, TX 76015-3129 | 2016-07-11 |
| 1669862587 | Individual | Specialist/Technologist | 2926 Waldon Park Dr, Orion, MI 48359-1336 | 2015-01-30 |
| 1780092817 | Individual | Skilled Nursing Facility | 5311 Albany Cir, Tobaccoville, NC 27050-9723 | 2014-08-01 |
| 1316361496 | Individual | Community/Behavioral Health | 2484 Ga Highway 100, Hogansville, GA 30230-3719 | 2014-02-11 |
| 1134534563 | Individual | Public Health or Welfare | 81 Plantation Street, Worcester, MA 01604 | 2014-06-24 |
| 1952724932 | Individual | Nursing Care | 1019 Westside Dr, Cuba, MO 65453-1025 | 2014-01-28 |
| 1639415920 | Individual | Residential Treatment Facility, Emotionally Disturbed Children | 1725 Shivers Rd, Columbia, SC 29210-5413 | 2012-12-14 |
| 1558663963 | Individual | Clinic/Center | 8105 Hidden Quail Ave, Las Vegas, NV 89131-4647 | 2010-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | INDIVIDUAL | 200 E Pine St, Somonauk, IL 60552-9812 |
| New York State Corporations | INDIVIDUAL & BUSINESS CONSULTING INC | 775 Park Ave Ste 255, Huntington, Ny 11743 |
| Virginia Business Entities | Individual & Employee Wellness LLC | 244 Ridgeway Drive, Farmville, Virginia 23901 |
| Oregon Corporations, Companies and Business Names | INDIVIDUAL & FAMILY GROWTH CENTER-MICHOL POLSON PHD | 204 Riverside Dr, Klamath Falls, OR 97601 |
| Colorado Business Entities | Individual & Family Recovery Inc. | 420 21st Ave., Suite 115, Longmont, CO 80501 |
| Oklahoma Business Registrations | INDIVIDUAL & FAMILY SERVICE L.L.C. | 2840 E 52nd St Ste 105, Tulsa, OK 74105 |
| Massachusetts Corporations | INDIVIDUAL & FAMILY SUPPORT CENTERS, INC. | 81 Hope Avenue, Worcester, MA 02721 |
| Virginia Business Entities | INDIVIDUAL & GROUP HEALTH PLANS INC. | 6025 Lee Hwy Ste 415, Chattanooga, Tennessee 37421 |
| Colorado Business Entities | Individual 1 | 17900 E 56th Ave, Apt 113, Denver, CO 80249 |
| Colorado Business Entities | Individual Academic Development, LLC | Po Box 2109, Parker, CO 80134 |
| Street Address |
12966 EUCLID ST SUITE 280 |
| City | GARDEN GROVE |
| State | CA |
| Zip Code | 92840-5200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487768891 | Affiliated Doctors of Orange County | Health Maintenance Organization | 12966 Euclid St, 340, Garden Grove, CA 92840-5200 | 2006-08-19 |
| 1467974105 | Anne Cathryn Axelson | Counselor | 12966 Euclid St, Suite 280, Garden Grove, CA 92840 | 2017-07-14 |
| 1184039703 | Kathryn Koenig | Counselor | 12966 Euclid St, Garden Grove, CA 92840-5200 | 2014-06-23 |
| 1821417809 | Eric Hamilton | Counselor | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2014-04-07 |
| 1831430784 | Patricia Eirich | Counselor | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2013-03-01 |
| 1174876379 | Karla J. Dimas | Counselor | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2012-10-25 |
| 1578835567 | Angie H Nguyen | Marriage & Family Therapist | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2012-02-06 |
| 1730496704 | Raquel Zamora | Social Worker | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2010-09-10 |
| 1629391263 | Michael Arn | Counselor | 12966 Euclid St, Garden Grove, CA 92840-5200 | 2010-03-10 |
| 1467781013 | Pathways Community Serivces LLC | Community/Behavioral Health | 12966 Euclid St, 200, 240 and 280, Garden Grove, CA 92840-5200 | 2009-12-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283808 | Kimberly Gaeta | Behavioral Analyst | 123935 Lewis Street, Ste 202, Garden Grove, CA 92840 | 2020-04-16 |
| 1396397170 | Rosa Cortez | Behavior Technician | 12443 Lewis Street, #201, Garden Grove, CA 92840 | 2019-07-12 |
| 1376005934 | Sekboppa Sor | Nurse Practitioner | An Lanh Free Clinic, 10861 Acacia Pkwy., Garden Grove, CA 92840 | 2019-04-03 |
| 1346730116 | Vinh Le Tran | Pharmacist | 12666 Brookhurst St. Suite 110, Garden Grove, CA 92840 | 2018-05-16 |
| 1841715232 | Scott R. Blair | Physician Assistant | 12828 Harbor Blvd Ste 200, Garden Grove, CA 92840 | 2017-08-07 |
| 1881049492 | Carmen Keally | Dietitian, Registered | 12602 9th St, Garden Grove, CA 92840 | 2016-05-02 |
| 1548688732 | House Call Medical Associates, Inc. | Internal Medicine | 12865 Main St Ste 105, Garden Grove, CA 92840 | 2014-04-03 |
| 1851733059 | Carly Ann Wade | Marriage & Family Therapist | 12755 Brookhurst St. Ste 116, Garden Grove, CA 92840 | 2013-07-29 |
| 1003159864 | Priyal Shah Ohri | Dentist | 10602 Chapman Ave, Suite 200, Garden Grove, CA 92840 | 2013-03-30 |
| 1770853244 | Joseph Pham | Pharmacist | 12001 Euclid St., Garden Grove, CA 92840 | 2011-12-30 |
| Find all providers in zip 92840 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780118646 | Karen Netherlain | Community/Behavioral Health | 10441 Stanford Ave, #659, Garden Grove, CA 92842-5200 | 2017-04-18 |
| 1679946552 | Korean Community Services Inc. | Community/Behavioral Health | 7281 Garden Grove Blvd Ste J, Garden Grove, CA 92841-4212 | 2015-11-02 |
| 1073861258 | Reach Behavior Services | Community/Behavioral Health | 13331 Garden Grove Blvd, Suite E, Garden Grove, CA 92843-2254 | 2012-08-20 |
| 1841335692 | College Community Services | Community/Behavioral Health | 11277 Garden Grove Blvd Ste 100, Garden Grove, CA 92843-1340 | 2007-02-20 |
| 1174610497 | Unidos Recovery Home | Community/Behavioral Health | 9842 13th St, Garden Grove, CA 92844-3171 | 2006-10-06 |
| 1508331042 | Special Service for Groups, Inc. | Community/Behavioral Health | 12900 Garden Grove Blvd Ste B225, Garden Grove, CA 92843-2040 | 2018-10-11 |
| 1811437874 | Mental Health Association of Orange County | Community/Behavioral Health | 12755 Brookhurst St Ste 116, Garden Grove, CA 92840-4855 | 2017-02-24 |
| 1326599218 | Boys & Girls Clubs of Garden Grove | Community/Behavioral Health | 10540 Chapman Ave, Garden Grove, CA 92840-3101 | 2016-10-17 |
| 1093189292 | Michael C. Cowick | Community/Behavioral Health | 12531 Harbor Blvd, G, Garden Grove, CA 92840-5824 | 2015-11-25 |
| 1598173346 | Rescare Behavior Services, Inc. | Community/Behavioral Health | 12900 Garden Grove Blvd, Suite 170, Garden Grove, CA 92843-2006 | 2014-07-24 |
| Find all providers in GARDEN GROVE | ||||
| City | GARDEN GROVE |
| Zip Code | 92840 |
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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.