Healthcare Provider Details

I. General information

NPI: 1972740363
Provider Name (Legal Business Name): TRILOGY GUIDED IMAGERY FOR HEALING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 CAMPUS DR
NEWPORT BEACH CA
92660-2120
US

IV. Provider business mailing address

5020 CAMPUS DR
NEWPORT BEACH CA
92660-2120
US

V. Phone/Fax

Practice location:
  • Phone: 949-296-7654
  • Fax:
Mailing address:
  • Phone: 949-296-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48863
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49203
License Number StateCA

VIII. Authorized Official

Name: DR. HELENE MICKEY WILSON
Title or Position: PRESIDENT
Credential: LMFT
Phone: 949-296-7654