Provider Demographics
NPI:1164145736
Name:WELL THERAPY PLLC
Entity Type:Organization
Organization Name:WELL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:IIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-697-4661
Mailing Address - Street 1:PO BOX 90632
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-9088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTHWEST LOOP 410 SUITE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:805-697-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty