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General NPI Number Information
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NPI Number | 1841021979
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Entity Type | Organization
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Legal Business Name | SERENITY WELLNESS GROUP
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Dates
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Enumeration Date | 08/10/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1471 LOST CREEK RD
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City | CHULA VISTA
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State | CA
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Zip | 91915-1608
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Country | US
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Telephone | 636-744-6996
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 LOST CREEK RD
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City | CHULA VISTA
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State | CA
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Zip | 91915-1608
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Country | US
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Telephone | 636-744-6996
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | COREY RUSSELL SCOTT
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Credential | PHARMD
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Telephone | 636-584-5078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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