Active NPI
Stephanie Lynne Davis, PH.D.
- Psychologist
- Mission Viejo, CA
National Provider Identifier
1154023570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 30293
- Practice address
- 26691 Plaza Ste 221
Mission Viejo, CA 92691-8582 - Phone
- (949) 534-2623
- NPI assigned
- Mar 20, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 30293 | CA | Primary |
Addresses
Primary practice location
26691 Plaza Ste 221
Mission Viejo, CA 92691-8582
Mailing address
26691 Plaza Ste 221
Mission Viejo, CA 92691-8582
Phone (949) 534-2623
Other names 1
- Stephanie Lynne Deverich
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 4, 2024 through Sep 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30293 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1154023570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26691 PLAZA STE 221",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926918582",
"telephone_number": "949-534-2623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26691 PLAZA STE 221",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926918582",
"telephone_number": "949-534-2623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "STEPHANIE",
"middle_name": "LYNNE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2023-03-20",
"certification_date": "2023-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "30293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "DEVERICH",
"middle_name": "LYNNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.