Provider Demographics
NPI:1083300701
Name:DRAW FROM WITHIN THERAPY STUDIO
Entity Type:Organization
Organization Name:DRAW FROM WITHIN THERAPY STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-890-0099
Mailing Address - Street 1:8080 LA MESA BLVD.
Mailing Address - Street 2:STUDIO # 105
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0361
Mailing Address - Country:US
Mailing Address - Phone:619-890-0099
Mailing Address - Fax:
Practice Address - Street 1:8080 LA MESA BLVD.
Practice Address - Street 2:STUDIO # 105
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0361
Practice Address - Country:US
Practice Address - Phone:619-890-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty