Provider Demographics
NPI:1629451661
Name:WHOLE LIFE RECOVERY, LLC
Entity Type:Organization
Organization Name:WHOLE LIFE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-294-5104
Mailing Address - Street 1:32122 CAMINO CAPISTRANO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3734
Mailing Address - Country:US
Mailing Address - Phone:949-294-5104
Mailing Address - Fax:
Practice Address - Street 1:32122 CAMINO CAPISTRANO
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3734
Practice Address - Country:US
Practice Address - Phone:949-294-5104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84751261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health