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General NPI Number Information
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NPI Number | 1225642531
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Entity Type | Organization
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Legal Business Name | INNER WISDOM PSYCHOTHERAPY ASSOC., INC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 2900 BRISTOL ST STE E103
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City | COSTA MESA
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State | CA
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Zip | 92626-7906
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Country | US
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Telephone | 714-814-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 KATAMA BAY DR
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City | COSTA MESA
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State | CA
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Zip | 92627-9030
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Country | US
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Telephone | 714-814-3336
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Fax | 602-467-3069
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Authorized Official
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Title or Position | OWNER
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Name | NAOMI BABCOCK
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Credential | LCSW
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Telephone | 714-814-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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