MEDICARE: BOUNTIFUL WELLNESS PSYCHOTHERAPY INC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396588687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNTIFUL WELLNESS PSYCHOTHERAPY INC.

Provider Business Mailing Address
First Line	:	1244 PINE ST STE 202
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-7215
Country	:	US
Telephone Number	:	805-369-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 PINE ST STE 202
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-7215
Country	:	US
Telephone Number	:	805-369-1038
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	LAUREN PHELPS
Credential	:
Telephone Number	:	805-369-1068

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	02/17/2026

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