Organization
JOURNEY OF LIFE PSYCHOLOGICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASEON OUTLAW PH.D (CEO)
(510) 463-1302
Entity
Organization
Contact information
Practice address
13847 E 14TH ST STE 202, SAN LEANDRO, CA 94578-2626
(510) 564-5955
(510) 817-4112
Mailing address
13847 E 14TH ST STE 202, SAN LEANDRO, CA 94578-2626
(510) 564-5955
(510) 817-4112
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CA228465
—
CA
Enumeration date
07/28/2020
Last updated
07/28/2020
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