OrganizationChild And Adolescent Behavioral Health CenterPsychologistBehavioral Health & Social Service ProvidersPractice Address17772 Irvine Blvd Ste 103, Tustin, CA 92780(714) 696-1385PECOS EnrollmentBased on the most recent information from CMS, provider Child And Adolescent Behavioral Health Center does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1053835496Provider TypeOrganizationFull NameChild And Adolescent Behavioral Health CenterSubpartNoEnumeration Date7/27/2017Last Updated9/10/2024Contact InformationPractice LocationPractice Address17772 Irvine Blvd Ste 103, Tustin, CA 92780Phone(714) 696-1385Fax(888) 972-4028Mailing LocationMailing Address17772 Irvine Blvd, Ste 103, Tustin, CA 92780-3256Phone(714) 696-1385Fax(888) 972-4028Authorized OfficialNameRichardson, Iris A (Partner)Phone(714) 696-1385Provider TaxonomiesCodeDescriptionLicenseCode103TC2200XPrimaryDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode103TH0100XDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode103TF0000XDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode103TB0200XDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode103TC0700XDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode103T00000XDescriptionPsychologistBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer