MEDICARE: HEALTHY WITHIN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	PSY14052	CA

General Provider Information

NPI Number	:	1013393511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY WITHIN INC

Provider Business Mailing Address
First Line	:	5665 OBERLIN DR STE 206
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1739
Country	:	US
Telephone Number	:	858-622-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 OBERLIN DR STE 206
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1739
Country	:	US
Telephone Number	:	858-622-0221
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. DIVYA KAKAIYA
Credential	:	PH.D.
Telephone Number	:	858-622-0221

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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