The Well Outreach Centr

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

THE WELL OUTREACH CENTR

Practice address

12717 14TH St
Yucaipa, CA 92399-1821

Phone

(909) 213-6708

NPI assigned

Jun 23, 2023

Organization subpart

Yes

Parent organization

N/AAs reported in NPPES

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

Authorized official

Name

Mrs. Vicki Wood, MED

Title

Executive Director

Phone

(909) 213-6708

Specialties & licenses 1

Addresses

Other names 2

• The Well Counseling Center Doing business as
• Wood Doing business as

Part of

The Well Outreach Centr

Locations

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1124704242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12717 14TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923991821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12717 14TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923991821",
            "telephone_number": "909-213-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELL OUTREACH CENTR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "N/A",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "909-213-6708",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Well Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Social Worker in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.