Healthcare Provider Details

I. General information

NPI: 1235948324
Provider Name (Legal Business Name): NESTED INTEGRAL COACHING CONSTELLATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 AVIATION BLVD APT 12
REDONDO BEACH CA
90278-1900
US

IV. Provider business mailing address

1600 ROSECRANS AVE BUILDING 7, FLOOR 4
MANHATTAN BEACH CA
90266
US

V. Phone/Fax

Practice location:
  • Phone: 424-327-3832
  • Fax:
Mailing address:
  • Phone: 424-327-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER EVANS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 424-327-3832