Healthcare Provider Details

I. General information

NPI: 1114884913
Provider Name (Legal Business Name): HOUSE OF REFUGE COUNSELING AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S H ST
BAKERSFIELD CA
93304-3930
US

IV. Provider business mailing address

425 S H ST
BAKERSFIELD CA
93304-3930
US

V. Phone/Fax

Practice location:
  • Phone: 661-364-6419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRICKSON AJEX PALVANNAN
Title or Position: PRESIDENT
Credential: MA, LPCC
Phone: 661-364-6419