NPIMap

Organization Active NPI

Mindsmith, a Psychological Professional Corporation

  • Clinical Psychologist
  • Ramona, CA
National Provider Identifier
1346720562
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY17908 Issued in CA
Legal business name
MINDSMITH, A PSYCHOLOGICAL PROFESSIONAL CORPORATION
Practice address
2330 Main St Ste D
Ramona, CA 92065-2539
Phone
(619) 376-7076
Fax
(619) 303-4270
NPI assigned
Aug 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

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

Authorized official

Name
Dr. Jennifer Ane Miller, PSYDNPI 1508874926
Title
Owner/President
Phone
(619) 378-7076

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY17908 CA Primary

Addresses

Primary practice location

2330 Main St Ste D
Ramona, CA 92065-2539

Mailing address

5575 Lake Park Way Ste 100
La Mesa, CA 91942-1669
Phone (619) 378-7076

Other practice location 1

5575 Lake Park Way Ste 100
LA Mesa, CA 91942-1669
Phone (619) 378-7076

Other identifiers 1

IdentifierTypeStateIssuer
586347MedicaidCA

Other names 1

  • Mindsmith Doing business as

National Provider Directory

National Provider Directory

Locations

5575 Lake Park Way
Ste 100
La Mesa, CA 91942
Phone (619) 378-7076

2330 Main St
Ste D
Ramona, CA 92065
Phone (619) 376-7076

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": "1534377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1346720562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5575 LAKE PARK WAY STE 100",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919421669",
            "telephone_number": "619-378-7076",
            "fax_number": "619-303-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 MAIN ST STE D",
            "city": "RAMONA",
            "state": "CA",
            "postal_code": "920652539",
            "telephone_number": "619-376-7076",
            "fax_number": "619-303-4270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5575 Lake Park Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "LA Mesa",
            "state": "CA",
            "postal_code": "919421669",
            "country_code": "US",
            "telephone_number": "619-378-7076",
            "fax_number": "619-303-4270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDSMITH, A PSYCHOLOGICAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "619-378-7076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "586347",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindsmith",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ramona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.