Canvas of Possibilities Psychological Services Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

CANVAS OF POSSIBILITIES PSYCHOLOGICAL SERVICES INC.

Practice address

3033 Fifth Ave Ste 230
San Diego, CA 92103-5873

Phone

(858) 805-5302

NPI assigned

Feb 11, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mariya Nikolayevna Kholodova, PH.D.NPI 1356416663

Title

Ceo

Phone

(858) 805-5302

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mariya Nikolayevna Kholodova, PH.D.

  • Psychologist
  • San Diego, CA
  • NPI 1356416663
  NPD Authorized official
• Alexa Theodora Douros

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1477172492
  NPD (past)
• Alyssa Hustwick

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1548660095
  NPD (past)
• Paul A Vanportfliet, PSY.D.

  • Psychologist
  • San Diego, CA
  • NPI 1982885158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1003560632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 FIFTH AVE STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035873",
            "telephone_number": "858-805-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 FIFTH AVE STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035873",
            "telephone_number": "858-805-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANVAS OF POSSIBILITIES PSYCHOLOGICAL SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "KHOLODOVA",
        "authorized_official_first_name": "MARIYA",
        "authorized_official_middle_name": "NIKOLAYEVNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-805-5302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy G. Canty Jr., MD
• Ethan Abraham Canty, MD
• Michelle Canty
• Nancy V. Canty, N.P.
• Timothy Giles Canty Sr., MD
• Canyon Hill Senior Home I
• Canyon Hill Senior Home II
• Kardo Canziani
• Alison Juliana Cao Romero
• Alicia Cao, MS, BCBA

• Adult Mental Health Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.