Provider Demographics
NPI:1790561850
Name:INNER WELLNESS PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:INNER WELLNESS PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-852-3226
Mailing Address - Street 1:9241 OLD STATE HWY UNIT 1170
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-1447
Mailing Address - Country:US
Mailing Address - Phone:530-852-3226
Mailing Address - Fax:415-741-1707
Practice Address - Street 1:9241 OLD STATE HWY UNIT 1170
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:CA
Practice Address - Zip Code:95658-1447
Practice Address - Country:US
Practice Address - Phone:530-852-3226
Practice Address - Fax:415-741-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty