Provider Demographics
NPI:1588253132
Name:THE INTEGRATIVE DEPTH PSYCHOLOGY INSTITUTE, INC.
Entity type:Organization
Organization Name:THE INTEGRATIVE DEPTH PSYCHOLOGY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-927-7009
Mailing Address - Street 1:595 E COLORADO BLVD STE 432
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5224
Mailing Address - Country:US
Mailing Address - Phone:323-927-7009
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 432
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5224
Practice Address - Country:US
Practice Address - Phone:323-927-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty