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General NPI Number Information
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NPI Number | 1356011217
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Entity Type | Organization
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Legal Business Name | PACIFIC INTEGRATIVE THERAPY INC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 12625 HIGH BLUFF DR STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-877-1750
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Fax | 855-554-1110
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Provider Business Mailing Address
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Address Line | 12636 HIGH BLUFF DR
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City | SAN DIEGO
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State | CA
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Zip | 92130-2022
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Country | US
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Telephone | 858-877-1860
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEDIEH AZADMEHR
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Credential | PH.D
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Telephone | 858-877-1750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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