Healthcare Provider Details

I. General information

NPI: 1821112764
Provider Name (Legal Business Name): WELLNEST EMOTIONAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 S VERMONT AVE
LOS ANGELES CA
90007
US

IV. Provider business mailing address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

V. Phone/Fax

Practice location:
  • Phone: 323-766-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA HIRSCH MARIN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 323-373-2400