Provider Demographics
NPI:1225635501
Name:SERENITY JOURNEY COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:SERENITY JOURNEY COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IXCHEL
Authorized Official - Middle Name:TELLEZ
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT, CATC-IV
Authorized Official - Phone:714-422-5773
Mailing Address - Street 1:155 N RIVERVIEW DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1225
Mailing Address - Country:US
Mailing Address - Phone:714-683-4870
Mailing Address - Fax:
Practice Address - Street 1:155 N RIVERVIEW DR STE 112
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1225
Practice Address - Country:US
Practice Address - Phone:714-422-5773
Practice Address - Fax:714-202-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty