Provider Demographics
NPI:1831715473
Name:WISDOM WELLNESS PSYCHOTHERAPY INC
Entity type:Organization
Organization Name:WISDOM WELLNESS PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASSITY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGENY-SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:916-546-5228
Mailing Address - Street 1:340 S. LEMON AVE #4028
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:916-546-5228
Mailing Address - Fax:
Practice Address - Street 1:340 S. LEMON AVE #4028
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789
Practice Address - Country:US
Practice Address - Phone:916-546-5228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty