Healthcare Provider Details

I. General information

NPI: 1386558039
Provider Name (Legal Business Name): PACIFIC WELLNESS THERAPY GROUP, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22866 MAYBROOK WAY
MORENO VALLEY CA
92557
US

IV. Provider business mailing address

12625 FREDERICK ST. STE I-5, #157
MORENO VALLEY CA
92553-5235
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-0135
  • Fax:
Mailing address:
  • Phone: 951-289-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: RECHELLE WEST
Title or Position: PRESIDENT
Credential: LCSW
Phone: 951-289-0135