NPIMap

Organization Active NPI

Soultenders, Inc.

  • Clinical Psychologist
  • Arcadia, CA
National Provider Identifier
1164617007
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 22818 Issued in CA
Legal business name
SOULTENDERS, INC.
Doing business as
Soultenders, Inc.
Practice address
41 E Foothill Blvd
Suite 102
Arcadia, CA 91006-2361
Phone
(626) 737-6034
Fax
(626) 737-6034
NPI assigned
Sep 13, 2007
Last updated
Jun 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

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

Authorized official

Name
Dr. Wendy Ludecke Bencosme, PH.D., LMFT
Title
Owner
Phone
(626) 701-4249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MFC38430 CA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY 22818 CA Primary

Addresses

Primary practice location

41 E Foothill Blvd
Suite 102
Arcadia, CA 91006-2361

Mailing address

41 E Foothill Blvd
Suite 102
Arcadia, CA 91006-2361
Phone (626) 701-4249

Other names 1

  • Soultenders, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150917001766 CA Part B Supplier - Clinic/Group Practice 6507170453 Receives reassigned benefits from 264 practitioners
Practice locations: Arcadia, CA; Whittier, CA; Thousand Oaks, CA; South Pasadena, CA; Signal Hill, CA; San Marino, CA; Rancho Cucamonga, CA; Pasadena, CA…

National Provider Directory

National Provider Directory
Tax ID family
Randy Christopher2 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.

Locations

245 E Olive Ave
Ste 400
Burbank, CA 91502
Phone (818) 823-6677

9795 Cabrini Dr
Ste 101
Burbank, CA 91504
Phone (818) 823-6677

17326 Edwards Rd
Ste A135
Cerritos, CA 90703
Phone (562) 222-5258

250 W 1st St
Ste 346
Claremont, CA 91711
Phone (909) 343-4550

2999 Overland Ave
Ste 209
Los Angeles, CA 90064
Phone (310) 893-6979

50 N Hill Ave
Ste 201A
Pasadena, CA 91106
Phone (626) 372-1999

1317 W Foothill Blvd
Ste 140
Upland, CA 91786
Phone (909) 343-4550

7630 Painter Ave
Ste C
Whittier, CA 90602
Phone (562) 203-0177

Practitioners & affiliated clinicians

Practitioners 314

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 314

NPI Registry JSON

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1164617007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD",
            "address_2": "SUITE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-701-4249",
            "fax_number": "626-737-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD",
            "address_2": "SUITE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-737-6034",
            "fax_number": "626-737-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULTENDERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "BENCOSME",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "LUDECKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-701-4249",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "MFC38430",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 22818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soultenders, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arcadia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.