Individual provider Active NPI

Cheryl L Nygard

  • Counseling Psychologist
  • Santa Rosa, CA
National Provider Identifier
1336452853
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PSY 24635 Issued in CA
Practice address
320 10TH St
Ste 202
Santa Rosa, CA 95401-5291
Phone
(707) 241-3411
NPI assigned
Jul 26, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PSY 24635 CA Primary

Addresses

Primary practice location

320 10TH St
Ste 202
Santa Rosa, CA 95401-5291

Mailing address

320 10TH St
Ste 202
Santa Rosa, CA 95401-5291
Phone (707) 241-3411

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
I20150629001007 CA Practitioner - Clinical Psychologist 9537471990 Reassigns benefits to 1 organization
Practice locations: Santa Rosa, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

320 10TH St
Suite 202
Santa Rosa, CA 95401-5291
Phone (707) 241-3411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY 24635CAMDCounseling Psychologist
24635CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lomi School Foundation CurrentSince Nov 4, 2016 Accepting new patients

Locations

534 B St
Santa Rosa, CA 95401
Phone (707) 430-8351

320 10th St
Ste 200
Santa Rosa, CA 95401
Phone (707) 536-7804

Organizations & group practices 1

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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1336452853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 10TH ST",
            "address_2": "STE 202",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015291",
            "telephone_number": "707-241-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 10TH ST",
            "address_2": "STE 202",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015291",
            "telephone_number": "707-241-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYGARD",
        "first_name": "CHERYL",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY 24635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.