Provider Demographics
NPI:1699400788
Name:CENTENNIAL HARVEST WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:CENTENNIAL HARVEST WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-917-1195
Mailing Address - Street 1:3355 N WHITE AVE UNIT 8287
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-6207
Mailing Address - Country:US
Mailing Address - Phone:323-917-1195
Mailing Address - Fax:
Practice Address - Street 1:2330 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:323-917-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831383272OtherLICENSED MARRIAGE, FAMILY THERAPIST