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General NPI Number Information
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NPI Number | 1528715869
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Entity Type | Organization
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Legal Business Name | ENVISION WELLNESS INC
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 5655 LINDERO CANYON RD STE 326
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4051
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Country | US
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Telephone | 58-569-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 516 WINNCASTLE ST
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0619
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Country | US
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Telephone | 818-519-2815
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. LITAL DIAMENT
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Credential | LMFT
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Telephone | 818-519-2815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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