Provider Demographics
NPI:1659052132
Name:WELLVITY HEALTH GROUP IPA, A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:WELLVITY HEALTH GROUP IPA, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:805-873-3324
Mailing Address - Street 1:622 E SANTA PAULA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2062
Mailing Address - Country:US
Mailing Address - Phone:085-873-3324
Mailing Address - Fax:
Practice Address - Street 1:622 E SANTA PAULA ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2062
Practice Address - Country:US
Practice Address - Phone:085-873-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty