Individual provider Active NPI

Crystal Rebecca Anne Cook

  • Marriage & Family Therapist
  • San Bernardino, CA
National Provider Identifier
1265814909
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
177557 Issued in CA
Practice address
1908 Business Center Dr Ste 220
San Bernardino, CA 92408
Phone
(909) 890-5930
NPI assigned
Jun 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 177557 CA Primary
Marriage & Family Therapist 106H00000X 83899 CA

Addresses

Primary practice location

1908 Business Center Dr Ste 220
San Bernardino, CA 92408

Mailing address

1908 Business Center Dr Ste 220
San Bernardino, CA 92408-3468
Phone (909) 890-5930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240123001805 CA Practitioner - Marriage and Family Therapist 3678925963 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
177557CAMDMarriage & Family Therapist
83899CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Soultenders, Inc. CurrentSince Jan 9, 2024 Accepting new patients
Soultenders Psychological Services, Inc. PastSince Jul 1, 2026 Accepting new patients

Locations

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

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

10532 Acacia St
Ste B4
Rch Cucamonga, CA 91730
Phone (909) 325-3766

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1265814909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 BUSINESS CENTER DR STE 220",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083468",
            "telephone_number": "909-890-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 BUSINESS CENTER DR STE 220",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-890-5930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "CRYSTAL",
        "middle_name": "REBECCA ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-18",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "177557",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "83899",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.