Provider Demographics
NPI:1437680303
Name:PSYCHOLOGY & WELLNESS
Entity Type:Organization
Organization Name:PSYCHOLOGY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-274-3486
Mailing Address - Street 1:1103 S HARBOR BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 S HARBOR BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2347
Practice Address - Country:US
Practice Address - Phone:626-274-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24393103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty