The Center for Stress and Healthy Aging, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

THE CENTER FOR STRESS AND HEALTHY AGING, LLC

Practice address

3411 3Rd Ave
San Diego, CA 92103-4906

Phone

(619) 722-5797

NPI assigned

Oct 4, 2018

Organization subpart

No

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

Authorized official

Name

Sofie Ling Champassak

Title

Owner

Phone

(619) 722-5797

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1083189161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26331",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921960331",
            "telephone_number": "619-722-5797",
            "fax_number": "858-761-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 3RD AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034906",
            "telephone_number": "619-722-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR STRESS AND HEALTHY AGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-04",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "CHAMPASSAK",
        "authorized_official_first_name": "SOFIE",
        "authorized_official_middle_name": "LING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-722-5797"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.