NPIMap

Organization Active NPI

Personal Evolution Psychotherapy, Inc

Doing business as Personal Evolution Psychotherapy

  • Multi-Specialty Clinic/Center
  • San Diego, CA
National Provider Identifier
1356779482
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PERSONAL EVOLUTION PSYCHOTHERAPY, INC
Doing business as
Personal Evolution Psychotherapy
Practice address
3737 Camino del Rio S
Ste. 302
San Diego, CA 92108-4006
Phone
(619) 787-6676
Fax
(619) 516-3594
NPI assigned
Oct 29, 2013
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
M. Sue Boyd, LCSW, BCD
Title
Clinical Director/Founder
Phone
(619) 787-6676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3737 Camino del Rio S
Ste. 302
San Diego, CA 92108-4006

Mailing address

3737 Camino del Rio S
Ste. 302
San Diego, CA 92108-4006
Phone (619) 787-6676

Other names 1

  • Personal Evolution Psychotherapy Doing business as

National Provider Directory

National Provider Directory

Locations

3737 Camino del Rio S
San Diego, CA 92108
Phone (619) 787-6676

3737 Camino del Rio S
Ste 302
San Diego, CA 92108
Phone (619) 629-1373

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1356779482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 CAMINO DEL RIO S",
            "address_2": "STE. 302",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084006",
            "telephone_number": "619-787-6676",
            "fax_number": "619-516-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 CAMINO DEL RIO S",
            "address_2": "STE. 302",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084006",
            "telephone_number": "619-787-6676",
            "fax_number": "619-516-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL EVOLUTION PSYCHOTHERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "M. SUE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/FOUNDER",
        "authorized_official_telephone_number": "619-787-6676",
        "authorized_official_credential": "LCSW, BCD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Personal Evolution Psychotherapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Personal Evolution Psychotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.