NPIMap

Organization Active NPI

High Desert Psychological Services

  • Psychologist
  • Victorville, CA
National Provider Identifier
1104463371
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
HIGH DESERT PSYCHOLOGICAL SERVICES
Practice address
15497 W Sand St
Victorville, CA 92392-2910
Phone
(442) 327-9311
Fax
(442) 327-9315
NPI assigned
Dec 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Eric Bahra, LCSWNPI 1053887117
Title
Owner
Phone
(714) 290-3009

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

15497 W Sand St
Victorville, CA 92392-2910

Mailing address

15497 W Sand St
Victorville, CA 92392-2910
Phone (442) 327-9311

Other practice location 1

14390 Park Ave
Victorville, CA 92392-2310
Phone (442) 327-9311

Other practice location 2

8253 White Oak Ave
Rancho Cucamonga, CA 91730-7671
Phone (442) 327-9311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200901001503 CA Part B Supplier - Clinic/Group Practice 2860819125 Receives reassigned benefits from 121 practitioners
Practice locations: Victorville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 148

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

View all 148

NPI Registry JSON

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

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1104463371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15497 W SAND ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922910",
            "telephone_number": "442-327-9311",
            "fax_number": "442-327-9315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15497 W SAND ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922910",
            "telephone_number": "442-327-9311",
            "fax_number": "442-327-9315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14390 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923922310",
            "country_code": "US",
            "telephone_number": "442-327-9311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8253 White Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917307671",
            "country_code": "US",
            "telephone_number": "442-327-9311",
            "fax_number": "442-327-9315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HIGH DESERT PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-05",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "BAHRA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-290-3009",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.