Healthcare Provider Details

I. General information

NPI: 1902651920
Provider Name (Legal Business Name): JOURNEY THERAPEUTICS MARRIAGE & FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27660 MERIDIAN ST
HEMET CA
92544-8370
US

IV. Provider business mailing address

2127 E FLORIDA AVE STE 262
HEMET CA
92544-4765
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-5052
  • Fax:
Mailing address:
  • Phone: 951-465-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA LYNN LLERA
Title or Position: PRESIDENT
Credential: MS LMFT
Phone: 951-465-5052