JOURNEY OF LIFE PSYCHOLOGICAL, INC. (NPI# 1073122958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073122958 |
| Entity Type | Organization |
| Organization Name | JOURNEY OF LIFE PSYCHOLOGICAL, INC. |
| Practice Address |
13847 E 14th St Ste 202 San Leandro CA 94578-2626 |
| Practice Telephone | 5105645955 |
| Practice Fax Number | 5108174112 |
| Mailing Telephone | 5105645955 |
| Mailing Fax Number | 5108174112 |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |
| Authorized Official Name | DR. JASEON OUTLAW (CEO) |
| Authorized Official Telephone | 5104631302 |
| Authorized Official Credential | PH.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CA228465 | 05 |
| Street Address |
13847 E 14TH ST STE 202 |
| City | SAN LEANDRO |
| State | CA |
| Zip Code | 94578-2626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861747552 | Jaseon S. Outlaw | Psychologist | 13847 E 14th St Ste 202, San Leandro, CA 94578-2626 | 2012-07-18 |
| 1639701857 | Journey To New Beginnings | Clinic/Center | 13847 E 14th St Ste 202, San Leandro, CA 94578-2626 | 2020-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952886327 | Keyla Itzel Monroy Rodriguez | Behavioral Analyst | 900 143rd Ave, Apt 269, San Leandro, CA 94578 | 2018-10-01 |
| 1962938340 | Shaylah Rigmaiden | Counselor | 3847 E14th St, #215, San Leandro, CA 94578 | 2017-05-04 |
| 1861864449 | Laurence Tang | Pharmacist | 13847 E. 14th Street, San Leandro, CA 94578 | 2015-10-22 |
| 1902227481 | Marissa Phan | Pharmacist | 15555 E. 14th Street #400, San Leandro, CA 94578 | 2013-12-30 |
| 1629403993 | Carly Renee Lucas | Counselor | 2257 Arlington Dr., San Leandro, CA 94578 | 2013-09-05 |
| 1871933317 | Javier Huerta | Counselor | 16335 E. 14th St, San Leandro, CA 94578 | 2013-06-28 |
| 1710231717 | Farida M Ismail | Non-emergency Medical Transport (VAN) | 1601 165th Ave, 107, San Leandro, CA 94578 | 2012-10-30 |
| 1487901989 | Amanda Dupuis | Counselor | 15942 Footlhill Blvd, San Leandro, CA 94578 | 2012-08-14 |
| 1629323506 | Mei Xiu Chua | Counselor | 13666 East 14th Street, San Leandro, CA 94578 | 2012-07-17 |
| 1730445644 | Nisreen Mesiwala Kothari | Ophthalmology | 15051 Hesperian Blvd Ste A, San Leandro, CA 94578 | 2012-04-04 |
| Find all providers in zip 94578 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639701857 | Journey To New Beginnings | Clinic/Center | 13847 E 14th St Ste 202, San Leandro, CA 94578-2626 | 2020-02-05 |
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| Find all providers with the same taxonomy | ||||
| City | SAN LEANDRO |
| Zip Code | 94578 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.