Provider Demographics
NPI:1912390493
Name:JOURNEY HOLISTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:JOURNEY HOLISTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:714-296-8053
Mailing Address - Street 1:10823 SKY PARK CIRCLE
Mailing Address - Street 2:SUITE G
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0000
Mailing Address - Country:US
Mailing Address - Phone:714-296-8052
Mailing Address - Fax:928-708-9620
Practice Address - Street 1:18023 SKY PARK CIR
Practice Address - Street 2:SUITE G
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6521
Practice Address - Country:US
Practice Address - Phone:714-296-8052
Practice Address - Fax:928-708-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43207261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder