Healthcare Provider Details

I. General information

NPI: 1184542656
Provider Name (Legal Business Name): AVENWELL MENTAL HEALTH & WELLNESS, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42055 50TH ST W STE 10
QUARTZ HILL CA
93536-3520
US

IV. Provider business mailing address

42055 50TH ST W STE 10
QUARTZ HILL CA
93536-3520
US

V. Phone/Fax

Practice location:
  • Phone: 661-228-3710
  • Fax:
Mailing address:
  • Phone: 661-228-3710
  • Fax: 661-206-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE HARRISON
Title or Position: PRESIDENT & PMHNP
Credential: PMHNP-BC
Phone: 510-681-3087