NPIMap

Organization Active NPI

Central Counseling Services Licensed Clinical Social Worker Inc

  • Clinical Social Worker
  • Riverside, CA
National Provider Identifier
1043704331
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
26872 Issued in CA
Legal business name
CENTRAL COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER INC
Practice address
6840 Indiana Ave Ste 275
Riverside, CA 92506-4279
Phone
(951) 778-0230
NPI assigned
Jun 19, 2018
Organization subpart
Yes
Parent organization
CENTRAL COUNSELING SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Sheralyn L. Shockey-Pope, LMFTNPI 1598035099
Title
Chief Operation Officer
Phone
(951) 778-0230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 26872 CA Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 37209 CA

Addresses

Primary practice location

6840 Indiana Ave Ste 275
Riverside, CA 92506-4279

Mailing address

6840 Indiana Ave Ste 275
Riverside, CA 92506-4279
Phone (951) 778-0230

Other practice location 1

29970 Technology Dr Ste 116
Murrieta, CA 92563-2647
Phone (951) 778-0230

Other names 1

  • Central Counseling Services Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240219000123 CA Part B Supplier - Clinic/Group Practice 2365886363 Receives reassigned benefits from 12 practitioners
Practice locations: Riverside, CA

National Provider Directory

National Provider Directory
Part of
Central Counseling Services

Locations

29970 Technology Dr
Ste 116
Murrieta, CA 92563
Phone (949) 201-8260

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1043704331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 INDIANA AVE STE 275",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064279",
            "telephone_number": "951-778-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6840 INDIANA AVE STE 275",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064279",
            "telephone_number": "951-778-0230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29970 Technology Dr Ste 116",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925632647",
            "country_code": "US",
            "telephone_number": "951-778-0230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRAL COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL COUNSELING SERVICES INC",
        "enumeration_date": "2018-06-19",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "SHOCKEY-POPE",
        "authorized_official_first_name": "SHERALYN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF OPERATION OFFICER",
        "authorized_official_telephone_number": "951-778-0230",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "26872",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "37209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Counseling Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.