Provider Demographics
NPI:1225642531
Name:INNER WISDOM PSYCHOTHERAPY ASSOC., INC
Entity type:Organization
Organization Name:INNER WISDOM PSYCHOTHERAPY ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-814-3336
Mailing Address - Street 1:1006 KATAMA BAY DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-9030
Mailing Address - Country:US
Mailing Address - Phone:714-814-3336
Mailing Address - Fax:602-467-3069
Practice Address - Street 1:2900 BRISTOL ST STE E103
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7906
Practice Address - Country:US
Practice Address - Phone:714-814-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty