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General NPI Number Information
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NPI Number | 1437238128
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Entity Type | Organization
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Legal Business Name | WES CORPRATION
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1321 ARCH ST STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2116
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Country | US
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Telephone | 267-256-4566
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Fax | 267-256-4562
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Provider Business Mailing Address
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Address Line | 1321 ARCH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2116
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Country | US
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Telephone | 267-256-4566
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Fax | 267-256-4562
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ABAYOMI IGE
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Credential | MD
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Telephone | 267-256-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 060130L
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License Number State | PA
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