Provider Demographics
NPI:1568200400
Name:WELLNESS IOP PC
Entity type:Organization
Organization Name:WELLNESS IOP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-998-0382
Mailing Address - Street 1:16260 VENTURA BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2255
Mailing Address - Country:US
Mailing Address - Phone:747-998-0382
Mailing Address - Fax:
Practice Address - Street 1:23388 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2733
Practice Address - Country:US
Practice Address - Phone:747-998-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty