TRIPLE MOON PSYCHOTHERAPY COLLECTIVE A LICENSED CLINICAL SOCIAL WORKER NPI 1306587837

NPI Information

  • NPI: 1306587837
  • Provider Name: TRIPLE MOON PSYCHOTHERAPY COLLECTIVE A LICENSED CLINICAL SOCIAL WORKER
  • Classification: Social Worker - 1041C0700X
  • Specialization: Clinical
  • Entity Type: Organization
  • Other Name: TRIPLE MOON PSYCHOTHERAPY COLLECTIVE A LICENSED SOCIAL WORKER CORP
  • Address: 12371 LEWIS ST STE 103
    GARDEN GROVE, CA
    ZIP 92840
  • Phone: (949) 868-8255

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NPI Details

TRIPLE MOON PSYCHOTHERAPY COLLECTIVE A LICENSED CLINICAL SOCIAL WORKER is a clinical social worker in Garden Grove, CA. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. TRIPLE MOON PSYCHOTHERAPY COLLECTIVE A LICENSED CLINICAL SOCIAL WORKER NPI is 1306587837. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Triple Moon Psychotherapy Collective A Licensed Social Worker Corp.

The provider's business location address is:

12371 LEWIS ST STE 103
GARDEN GROVE, CA
ZIP 92840-687
Phone: (949) 868-8255

The provider's authorized official is Amy Le Reve Renderos .
The authorized official title is Director and has the following contact phone number (951) 870-1528.

The enumeration date for this NPI number is 4/6/2022 and was last updated on 10/4/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11041C0700XSocial WorkerClinicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100215178MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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