Phoenix Therapy

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

PSY24744 Issued in CA

Legal business name

PHOENIX THERAPY

Practice address

12530 10TH St Ste D
Chino, CA 91710-3520

Phone

(714) 473-1043

NPI assigned

Jul 1, 2016

Last updated

Jul 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kristen M White, PSY.D.

Title

Owner

Phone

(714) 473-1043

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467331200000",
    "number": "1235581240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12530 10TH ST STE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103520",
            "telephone_number": "714-473-1043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12530 10TH ST STE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103520",
            "telephone_number": "714-473-1043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-01",
        "last_updated": "2016-07-01",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-473-1043",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "PSY24744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Chino, CA
• Providers in Chino, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.