Ivy Glenn Wellness

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

IVY GLENN WELLNESS

Practice address

30011 Ivy Glenn Dr Ste 216
Laguna Niguel, CA 92677-5018

Phone

(949) 484-9161

NPI assigned

Dec 16, 2018

Organization subpart

No

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

Authorized official

Name

Kristin Bachman, PHD

Title

Owner

Phone

(858) 663-0651

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544918400000",
    "number": "1417428665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30011 IVY GLENN DR STE 216",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775018",
            "telephone_number": "949-484-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30011 IVY GLENN DR STE 216",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775018",
            "telephone_number": "949-484-9161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY GLENN WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A",
        "authorized_official_last_name": "BACHMAN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-663-0651",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Psychologist in California

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