MEDICARE: TRILOGY GUIDED IMAGERY FOR HEALING, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist	48863	CA
4	106H00000X	Marriage & Family Therapist	49203	CA

General Provider Information

NPI Number	:	1972740363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILOGY GUIDED IMAGERY FOR HEALING, INC.

Provider Business Mailing Address
First Line	:	5020 CAMPUS DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2120
Country	:	US
Telephone Number	:	949-296-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 CAMPUS DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2120
Country	:	US
Telephone Number	:	949-296-7654
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HELENE MICKEY WILSON
Credential	:	LMFT
Telephone Number	:	949-296-7654

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	10/25/2010

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