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General NPI Number Information
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NPI Number | 1669285359
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Entity Type | Organization
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Legal Business Name | CGM WELLNESS GROUP
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3155 OLD CONEJO RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2151
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Country | US
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Telephone | 562-754-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 171 E THOUSAND OAKS BLVD STE 207
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5748
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Country | US
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Telephone | 562-754-2310
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CANDICE FEINBERG
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Credential | PSY.D.
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Telephone | 562-754-2310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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