Provider Demographics
NPI:1760116297
Name:LOOK INSIDE THERAPY, LLC
Entity Type:Organization
Organization Name:LOOK INSIDE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:WATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:571-449-7837
Mailing Address - Street 1:PO BOX 806054
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-6054
Mailing Address - Country:US
Mailing Address - Phone:571-449-7837
Mailing Address - Fax:571-449-7837
Practice Address - Street 1:4339 RIDGEWOOD CENTER DR # 123
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5308
Practice Address - Country:US
Practice Address - Phone:571-449-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health