Provider Demographics
NPI:1528715869
Name:ENVISION WELLNESS INC
Entity type:Organization
Organization Name:ENVISION WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMENT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-519-2815
Mailing Address - Street 1:516 WINNCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0619
Mailing Address - Country:US
Mailing Address - Phone:818-519-2815
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD STE 326
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4051
Practice Address - Country:US
Practice Address - Phone:058-569-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health