JOURNEY OF LIFE PSYCHOLOGICAL INC. NPI 1073122958

NPI Information

NPI: 1073122958
Provider Name: JOURNEY OF LIFE PSYCHOLOGICAL, INC.
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
13847 E 14TH ST STE 202
SAN LEANDRO, CA
ZIP 94578
Phone: (510) 564-5955
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JOURNEY OF LIFE PSYCHOLOGICAL, INC. is a mental health (including community mental health center) clinic center in San Leandro, CA. JOURNEY OF LIFE PSYCHOLOGICAL, INC. NPI is 1073122958. The provider is registered as an organization entity type.

The provider's business location address is:

13847 E 14TH ST STE 202
SAN LEANDRO, CA
ZIP 94578-626
Phone: (510) 564-5955
Fax: (510) 817-4112

The provider's authorized official is Jaseon Outlaw .
The authorized official title is Ceo and has the following contact phone number (510) 463-1302.

The enumeration date for this NPI number is 7/28/2020 and was last updated on 7/28/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CA228465	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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