MEDICARE: SERENITY JOURNEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1225635501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY JOURNEY LLC

Provider Business Mailing Address
First Line	:	155 N RIVERVIEW DR STE 112
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-1225
Country	:	US
Telephone Number	:	714-422-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N RIVERVIEW DR STE 112
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-1225
Country	:	US
Telephone Number	:	714-422-5773
Fax Number	:	714-202-9870

Authorized Official
Title or Position	:	LICENSED MARRIAGE FAMILY THERAPIST
Name	:	MRS. IXCHEL TELLEZ FONSECA
Credential	:	PSY.D, LMFT, CATC-IV
Telephone Number	:	714-422-5773

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/02/2025

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Directions to “SERENITY JOURNEY LLC ” Practice Location

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