Healthcare Provider Details

I. General information

NPI: 1780547588
Provider Name (Legal Business Name): THE THERAPY INNOVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N CUYAMACA ST STE 107
EL CAJON CA
92020-1865
US

IV. Provider business mailing address

900 N CUYAMACA ST STE 107
EL CAJON CA
92020-1865
US

V. Phone/Fax

Practice location:
  • Phone: 619-405-2476
  • Fax: 619-566-3578
Mailing address:
  • Phone: 619-405-2476
  • Fax: 619-566-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LOPEZ
Title or Position: OWNER
Credential: MFT
Phone: 619-405-2476