Journey of Life Psychological, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JOURNEY OF LIFE PSYCHOLOGICAL, INC.

Practice address

13847 E 14TH St Ste 202
San Leandro, CA 94578-2626

Phone

(510) 564-5955

Fax

(510) 817-4112

NPI assigned

Jul 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jaseon Outlaw, PH.DNPI 1861747552

Title

Ceo

Phone

(510) 463-1302

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaseon S. Outlaw, PHD

  • Clinical Psychologist
  • San Leandro, CA
  • NPI 1861747552
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1073122958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13847 E 14TH ST STE 202",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782626",
            "telephone_number": "510-564-5955",
            "fax_number": "510-817-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13847 E 14TH ST STE 202",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782626",
            "telephone_number": "510-564-5955",
            "fax_number": "510-817-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEY OF LIFE PSYCHOLOGICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "OUTLAW",
        "authorized_official_first_name": "JASEON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-463-1302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA228465",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph C. Cheng, M.D., Inc.
• Joseph M. Farber M.D., Inc.
• Daryl Joseph
• Larnelle Marie Joshan
• Journey of Life Counseling and Assessment Services
• Jena Joy, MD
• Eli Joyce
• Akkeya Joyner
• Jtreliable Transportation
• Tiffany Guo Ju

• Mental Health Clinic/Center (Including Community Mental Health Center) in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.