Active NPI
Holli Eaton, PSYD
- Psychologist
- Glendale, CA
National Provider Identifier
1164188256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 19265
- Practice address
- 1509 Wilson Ter
Glendale, CA 91206-4007 - Phone
- (626) 815-5008
- NPI assigned
- Nov 12, 2021
- Last updated
- Nov 12, 2021
- 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 | 19265 | CA | Primary |
Addresses
Primary practice location
1509 Wilson Ter
Glendale, CA 91206-4007
Mailing address
PO Box 158
South Pasadena, CA 91031-0158
Phone (626) 664-2044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19265 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1164188256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 158",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910310158",
"telephone_number": "626-664-2044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 WILSON TER",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912064007",
"telephone_number": "626-815-5008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EATON",
"first_name": "HOLLI",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-12",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "19265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.