Healthcare Provider Details

I. General information

NPI: 1649103193
Provider Name (Legal Business Name): WEST COAST INTEGRATIVE MENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 WILSHIRE BLVD STE 250
SANTA MONICA CA
90403-4749
US

IV. Provider business mailing address

2730 WILSHIRE BLVD STE 250
SANTA MONICA CA
90403-4749
US

V. Phone/Fax

Practice location:
  • Phone: 424-218-9068
  • Fax: 888-965-9596
Mailing address:
  • Phone: 424-218-9068
  • Fax: 888-965-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA WOLFE-GRADY
Title or Position: CO-OWNER
Credential: LMFT
Phone: 805-881-3410