NPIMap

Organization Active NPI

Mindbodyology Family Therapy Inc

  • Health Service Clinic/Center
  • Vista, CA
National Provider Identifier
1073077111
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
MINDBODYOLOGY FAMILY THERAPY INC
Practice address
440 S Melrose Dr Ste 200
Vista, CA 92081-6666
Phone
(833) 444-6463
NPI assigned
Jan 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Authorized official

Name
Shaliss Padilla, LMFTNPI 1457685141
Title
Owner
Phone
(833) 444-6463

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Family PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0000X
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

440 S Melrose Dr Ste 200
Vista, CA 92081-6666

Mailing address

440 S Melrose Dr Ste 202
Vista, CA 92081-6666
Phone (833) 444-6463

Other names 1

  • MINDBODYOLOGY Doing business as

National Provider Directory

National Provider Directory

Locations

440 S Melrose Dr
Ste 200
Vista, CA 92081
Phone (833) 444-6463

440 S Melrose Dr
Ste 202
Vista, CA 92081

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1073077111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 S MELROSE DR STE 202",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920816666",
            "telephone_number": "833-444-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 S MELROSE DR STE 200",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920816666",
            "telephone_number": "833-444-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBODYOLOGY FAMILY THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "SHALISS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "833-444-6463",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINDBODYOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MINDBODYOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.