Body Mind Spirit Iop Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY9840 Issued in CA

Legal business name

BODY MIND SPIRIT IOP INC

Practice address

665 Camino de Los Mares Ste 104
San Clemente, CA 92673

Phone

(949) 248-7377

Fax

(866) 805-2796

NPI assigned

Sep 25, 2014

Organization subpart

No

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

Authorized official

Name

William Martin, PH.D

Title

Ceo

Phone

(949) 247-7377

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535068800000",
    "number": "1255733853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES STE 104",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732840",
            "telephone_number": "949-248-7377",
            "fax_number": "866-805-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES STE 104",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92673",
            "telephone_number": "949-248-7377",
            "fax_number": "866-805-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY MIND SPIRIT IOP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-25",
        "last_updated": "2018-08-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-247-7377",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY9840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilene M. Blaisch, MSW, LSCW
• Kristin Blaney, MA, MFT
• Jack Holland Boatman, DDS
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• Psychologist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; 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.