Individual provider Active NPI

Colette Lord, PH.D.

  • Clinical Psychologist
  • Del Mar, CA
National Provider Identifier
1184790933
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
21497 Issued in CA
Practice address
317 14TH St Ste E
Del Mar, CA 92014-2554
Phone
(858) 276-8831
Fax
(858) 215-5459
NPI assigned
Nov 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 21497 CA
Clinical Psychologist 103TC0700X 21497 CA Primary

Addresses

Primary practice location

317 14TH St Ste E
Del Mar, CA 92014-2554

Mailing address

317 14TH St Ste E
Del Mar, CA 92014-2554
Phone (858) 276-8831

Other names 1

  • Colette Poehling Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2024 through Apr 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 21497CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1184790933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 14TH ST STE E",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142554",
            "telephone_number": "858-276-8831",
            "fax_number": "858-215-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 14TH ST STE E",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142554",
            "telephone_number": "858-276-8831",
            "fax_number": "858-215-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORD",
        "first_name": "COLETTE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-24",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 21497",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "21497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLETTE",
            "last_name": "POEHLING",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Del Mar, CA

Sources for this page

Verify at the official NPI Registry.