NPIMap

Organization Active NPI

Psychiatric & Counseling Medical Clinics, Inc.

  • Specialist
  • San Bernardino, CA
National Provider Identifier
1073625166
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A29607 Issued in CA
Legal business name
PSYCHIATRIC & COUNSELING MEDICAL CLINICS, INC.
Practice address
1830 Commercenter E
San Bernardino, CA 92408-3406
Phone
(909) 885-5608
Fax
(909) 889-7096
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Chandra Diane Desilva, M.D.
Title
Vice President
Phone
(909) 885-5608

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A29607 CA Primary

Addresses

Primary practice location

1830 Commercenter E
San Bernardino, CA 92408-3406

Mailing address

PO Box 6306
San Bernardino, CA 92412-6306
Phone (909) 885-5608

Other names 1

  • Forensic Psychiatric Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Forensic Psychiatric Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073625166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6306",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924126306",
            "telephone_number": "909-885-5608",
            "fax_number": "909-889-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 COMMERCENTER E",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083406",
            "telephone_number": "909-885-5608",
            "fax_number": "909-889-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC & COUNSELING MEDICAL CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESILVA",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "909-885-5608",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A29607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forensic Psychiatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.