Healthcare Provider Details

I. General information

NPI: 1366388092
Provider Name (Legal Business Name): PSYCHE INTEGRATIVE WELLNESS, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S IVY AVE
MONROVIA CA
91016-2827
US

IV. Provider business mailing address

517 S IVY AVE
MONROVIA CA
91016-2827
US

V. Phone/Fax

Practice location:
  • Phone: 760-491-3146
  • Fax:
Mailing address:
  • Phone: 760-491-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACLYN HILL
Title or Position: OWNER/NP
Credential: PMHNP
Phone: 760-491-3146