Healthcare Provider Details

I. General information

NPI: 1659043792
Provider Name (Legal Business Name): THERAPEUTIC AND WELLNESS SOLUTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 RANCHEROS DR STE 208
SAN MARCOS CA
92069-2978
US

IV. Provider business mailing address

330 RANCHEROS DR STE 208
SAN MARCOS CA
92069-2978
US

V. Phone/Fax

Practice location:
  • Phone: 760-566-5516
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MORAN
Title or Position: LMFT
Credential:
Phone: 760-566-5516