NPIMap

Organization Active NPI

San Diego Therapy Group, a Professional Psychology Corporation

  • Mental Health Counselor
  • San Diego, CA
National Provider Identifier
1235639733
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SAN DIEGO THERAPY GROUP, A PROFESSIONAL PSYCHOLOGY CORPORATION
Practice address
3760 Convoy St.
Ste. 118
San Diego, CA 92111
Phone
(619) 800-0821
Fax
(858) 292-0143
NPI assigned
Feb 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

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

Authorized official

Name
Nicole Guzman, PSY.D.
Title
Ceo
Phone
(619) 800-0821

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 24952 CA

Addresses

Primary practice location

3760 Convoy St.
Ste. 118
San Diego, CA 92111

Mailing address

3760 Convoy St.
Ste. 118
San Diego, CA 92111
Phone (619) 800-0821

Other names 1

  • San Diego Therapy Group Doing business as

National Provider Directory

National Provider Directory

Locations

3760 Convoy St
Ste 118
San Diego, CA 92111
Phone (619) 251-4618

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1235639733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 CONVOY ST.",
            "address_2": "STE. 118",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92111",
            "telephone_number": "619-800-0821",
            "fax_number": "858-292-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 CONVOY ST.",
            "address_2": "STE. 118",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92111",
            "telephone_number": "619-800-0821",
            "fax_number": "858-292-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO THERAPY GROUP, A PROFESSIONAL PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "GUZMAN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-800-0821",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "24952",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.