NPIMap

Organization Active NPI

Acacia Psychological Corporation

  • Clinical Psychologist
  • Davis, CA
National Provider Identifier
1295279883
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
26685 Issued in CA
Legal business name
ACACIA PSYCHOLOGICAL CORPORATION
Practice address
207 E St Ste B
Davis, CA 95616-4523
Phone
(805) 472-6099
Fax
(805) 472-6099
NPI assigned
Dec 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Authorized official

Name
Jess Rodriguez
Title
Chief Business Officer
Phone
(805) 472-6099

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 26685 CA Primary

Addresses

Primary practice location

207 E St Ste B
Davis, CA 95616-4523

Mailing address

281 Magnolia Ave Ste 300
Goleta, CA 93117-3608
Phone (805) 472-6099

Other names 1

  • Acacia Counseling & Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Acacia Psychological Corporation9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

203 F St
Ste E
Davis, CA 95616
Phone (530) 206-9996

207 E St
Ste B
Davis, CA 95616
Phone (530) 206-9996

Practitioners & affiliated clinicians

Practitioners 1

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": "1481760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1295279883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 MAGNOLIA AVE STE 300",
            "city": "GOLETA",
            "state": "CA",
            "postal_code": "931173608",
            "telephone_number": "805-472-6099",
            "fax_number": "805-472-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E ST STE B",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956164523",
            "telephone_number": "805-472-6099",
            "fax_number": "805-472-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACACIA PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-15",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "JESS",
        "authorized_official_title_or_position": "CHIEF BUSINESS OFFICER",
        "authorized_official_telephone_number": "805-472-6099"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "26685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acacia Counseling & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Acacia Counseling & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; 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.