Organization Active NPI

Mental Wellness for Life a Nursing Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Valencia, CA
National Provider Identifier
1982326740
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MENTAL WELLNESS FOR LIFE A NURSING CORPORATION
Practice address
28212 Kelly Johnson Pkwy Ste 215
Valencia, CA 91355-5090
Phone
(818) 688-6826
Fax
(877) 349-4481
NPI assigned
Sep 16, 2022
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Jacquelyn Victoria Zommick, PMHNP-BCNPI 1073282786
Title
President/Psych Nurse Practitioner
Phone
(818) 688-6826

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

28212 Kelly Johnson Pkwy Ste 215
Valencia, CA 91355-5090

Mailing address

28212 Kelly Johnson Pkwy Ste 215
Valencia, CA 91355-5090
Phone (818) 688-6826

Other practice location 1

23500 Park Sorrento Unit A4
Calabasas, CA 91302-4117
Phone (818) 688-6826

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221227002448 CA Part B Supplier - Clinic/Group Practice 7214307727 Receives reassigned benefits from 5 practitioners
Practice locations: Calabasas, CA; Van Nuys, CA; Lancaster, CA; Valencia, CA

National Provider Directory

National Provider Directory

Locations

23500 Park Sorrento
Unit A4
Calabasas, CA 91302
Phone (310) 895-7122

44151 15th St W
Ste 210
Lancaster, CA 93534
Phone (310) 895-7122

28212 Kelly Johnson Pkwy
Ste 215
Valencia, CA 91355
Phone (310) 314-8250

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1982326740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY STE 215",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555090",
            "telephone_number": "818-688-6826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY STE 215",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555090",
            "telephone_number": "818-688-6826",
            "fax_number": "877-349-4481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23500 Park Sorrento Unit A4",
            "address_purpose": "LOCATION",
            "city": "Calabasas",
            "state": "CA",
            "postal_code": "913024117",
            "country_code": "US",
            "telephone_number": "818-688-6826",
            "fax_number": "877-349-4481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MENTAL WELLNESS FOR LIFE A NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-16",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "ZOMMICK",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "VICTORIA",
        "authorized_official_title_or_position": "PRESIDENT/PSYCH NURSE PRACTITIONER",
        "authorized_official_telephone_number": "818-688-6826",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.