Individual provider Active NPI

Amanda Courvoisier, PSYD

  • Clinical Psychologist
  • La Mirada, CA
National Provider Identifier
1053651919
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY21207 Issued in CA
Practice address
12625 La Mirada Blvd.
Suite 202
La Mirada,, CA 90638-2211
Phone
(562) 903-4800
NPI assigned
Feb 28, 2013
Last updated
Feb 28, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY21207 CA Primary

Addresses

Primary practice location

12625 La Mirada Blvd.
Suite 202
La Mirada,, CA 90638-2211

Mailing address

12625 La Mirada Blvd.
Suite 202
La Mirada,, CA 90638-2211
Phone (562) 903-4800

Other identifiers 1

IdentifierTypeStateIssuer
PSY21207OtherCAPSYCHOLOGY LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Nov 13, 2019 through Nov 13, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21207CAMDAddiction (Substance Use Disorder) Counselor
PSY21207CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Biola Counseling Center Clinical Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1053651919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 LA MIRADA BLVD.",
            "address_2": "SUITE 202",
            "city": "LA MIRADA,",
            "state": "CA",
            "postal_code": "906382211",
            "telephone_number": "562-903-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 LA MIRADA BLVD.",
            "address_2": "SUITE 202",
            "city": "LA MIRADA,",
            "state": "CA",
            "postal_code": "906382211",
            "telephone_number": "562-903-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COURVOISIER",
        "first_name": "AMANDA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE",
            "identifier": "PSY21207",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mirada, CA

Sources for this page

Verify at the official NPI Registry.