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General NPI Number Information
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NPI Number | 1801520291
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Entity Type | Organization
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Legal Business Name | PEAK MENTAL WELLNESS
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 5405 MOREHOUSE DR STE 120
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City | SAN DIEGO
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State | CA
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Zip | 92121-4723
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Country | US
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Telephone | 757-355-3942
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Fax | 626-345-5584
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Provider Business Mailing Address
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Address Line | 261 N MADISON AVE APT 309
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City | PASADENA
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State | CA
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Zip | 91101-4476
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Country | US
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Telephone | 757-355-3942
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Fax | 626-345-5584
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MR. JASON YENGST
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Credential |
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Telephone | 619-807-1830
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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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