Healthcare Provider Details

I. General information

NPI: 1710869326
Provider Name (Legal Business Name): PEARL PATHWAYS INDIVIDUAL AND FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E COMMONWEALTH AVE APT 315
FULLERTON CA
92832-4908
US

IV. Provider business mailing address

6 CENTERPOINTE DR STE 700
LA PALMA CA
90623-2545
US

V. Phone/Fax

Practice location:
  • Phone: 562-726-5976
  • Fax:
Mailing address:
  • Phone: 562-726-5976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: D'ANDRA PEARL JOHNSON
Title or Position: CEO, LMFT
Credential: LMFT
Phone: 562-231-7404