Healthcare Provider Details

I. General information

NPI: 1245198233
Provider Name (Legal Business Name): SACRED JOURNEY COUNSELING AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MOORE RD
CERES CA
95307-6735
US

IV. Provider business mailing address

3700 MOORE RD
CERES CA
95307-6735
US

V. Phone/Fax

Practice location:
  • Phone: 209-288-4887
  • Fax:
Mailing address:
  • Phone: 209-288-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGILENE NICHOLE FORREST
Title or Position: OWNER
Credential: LMFT, LPCC, SUDCC IV
Phone: 209-735-2244