Provider Demographics
NPI:1679282446
Name:INTERWOVEN THERAPY COLLECTIVE INC
Entity type:Organization
Organization Name:INTERWOVEN THERAPY COLLECTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-548-5562
Mailing Address - Street 1:1807 ROBINSON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7634
Mailing Address - Country:US
Mailing Address - Phone:619-736-0621
Mailing Address - Fax:
Practice Address - Street 1:1807 ROBINSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7634
Practice Address - Country:US
Practice Address - Phone:619-736-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty