Provider Demographics
NPI:1619280740
Name:CHANG, EILEEN M (LMFT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23101 LAKE CENTER DR STE 335
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6819
Mailing Address - Country:US
Mailing Address - Phone:949-299-0288
Mailing Address - Fax:
Practice Address - Street 1:23101 LAKE CENTER DR STE 335
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6819
Practice Address - Country:US
Practice Address - Phone:949-299-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149751106H00000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist