Provider Demographics
NPI:1679239354
Name:ADDICTION THERAPY NEWPORT BEACH
Entity type:Organization
Organization Name:ADDICTION THERAPY NEWPORT BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYSE
Authorized Official - Middle Name:IPEK
Authorized Official - Last Name:AYKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:562-607-2496
Mailing Address - Street 1:4540 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1815
Mailing Address - Country:US
Mailing Address - Phone:562-607-2496
Mailing Address - Fax:
Practice Address - Street 1:4540 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1815
Practice Address - Country:US
Practice Address - Phone:562-607-2496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty