MEDICARE: INNOVATIVE WELLNESS CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker
3	171400000X	Health & Wellness Coach
4	171M00000X	Case Manager/Care Coordinator
5	172V00000X	Community Health Worker
6	252Y00000X	Early Intervention Provider Agency
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
8	363LF0000X	Family Nurse Practitioner
9	374J00000X	Doula
10	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184484438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE WELLNESS CONSULTING

Provider Business Mailing Address
First Line	:	236 W MOUNTAIN ST STE 103
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-2968
Country	:	US
Telephone Number	:	213-394-5889
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4559
Country	:	US
Telephone Number	:	323-924-9084
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	NAKEYA FIELDS
Credential	:
Telephone Number	:	213-394-5889

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	04/26/2024

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