Healthcare Provider Details

I. General information

NPI: 1083300701
Provider Name (Legal Business Name): DRAW FROM WITHIN THERAPY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 LA MESA BLVD. STUDIO # 105
LA MESA CA
91942-0361
US

IV. Provider business mailing address

8080 LA MESA BLVD. STUDIO # 105
LA MESA CA
91942-0361
US

V. Phone/Fax

Practice location:
  • Phone: 619-890-0099
  • Fax:
Mailing address:
  • Phone: 619-890-0099
  • Fax:

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: MR. JOHN WEAD
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-890-0099