Provider Demographics
NPI:1649762444
Name:CENTER FOR CLINICAL INNOVATIONS AND WELLNESS, INC.
Entity Type:Organization
Organization Name:CENTER FOR CLINICAL INNOVATIONS AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO-JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-623-1211
Mailing Address - Street 1:13601 WHITTIER BLVD STE 308-309
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1902
Mailing Address - Country:US
Mailing Address - Phone:562-623-1211
Mailing Address - Fax:562-623-1211
Practice Address - Street 1:13601 WHITTIER BLVD STE 308-309
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605
Practice Address - Country:US
Practice Address - Phone:562-623-1211
Practice Address - Fax:562-623-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty