Healthcare Provider Details

I. General information

NPI: 1720992654
Provider Name (Legal Business Name): BODHI WELLNESS COLLECTIVE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 308
HERMOSA BEACH CA
90254-2702
US

IV. Provider business mailing address

2200 PACIFIC COAST HWY STE 308
HERMOSA BEACH CA
90254-2702
US

V. Phone/Fax

Practice location:
  • Phone: 310-818-3630
  • Fax:
Mailing address:
  • Phone: 310-818-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN MARTIN FOLEY
Title or Position: PRESIDENT
Credential: LMFT
Phone: 310-818-3630