MEDICARE: INSTITUTE OF MODERN RECOVERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional Counselor
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1952714321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF MODERN RECOVERY

Provider Business Mailing Address
First Line	:	2725 CONGRESS ST STE 1D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2766
Country	:	US
Telephone Number	:	619-288-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 CONGRESS ST
Second Line	:	SUITE 1D
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2757
Country	:	US
Telephone Number	:	619-288-6866
Fax Number	:

Authorized Official
Title or Position	:	CEO-LMFT
Name	:	MR. CRESTON DAVIS
Credential	:	MA
Telephone Number	:	619-288-6866

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	01/02/2026

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Directions to “INSTITUTE OF MODERN RECOVERY ” Practice Location

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