Healthcare Provider Details

I. General information

NPI: 1669285359
Provider Name (Legal Business Name): CGM WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 OLD CONEJO RD
THOUSAND OAKS CA
91320-2151
US

IV. Provider business mailing address

171 E THOUSAND OAKS BLVD STE 207
THOUSAND OAKS CA
91360-5748
US

V. Phone/Fax

Practice location:
  • Phone: 562-754-2310
  • Fax:
Mailing address:
  • Phone: 562-754-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CANDICE FEINBERG
Title or Position: CEO
Credential: PSY.D.
Phone: 562-754-2310