Provider Demographics
NPI:1801520291
Name:PEAK MENTAL WELLNESS
Entity type:Organization
Organization Name:PEAK MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:YENGST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-807-1830
Mailing Address - Street 1:261 N MADISON AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4476
Mailing Address - Country:US
Mailing Address - Phone:757-355-3942
Mailing Address - Fax:626-345-5584
Practice Address - Street 1:5405 MOREHOUSE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4723
Practice Address - Country:US
Practice Address - Phone:757-355-3942
Practice Address - Fax:626-345-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty