Integrative Mind & Body Psychotherapy, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY26623 Issued in CA

Legal business name

INTEGRATIVE MIND & BODY PSYCHOTHERAPY, INC.

Practice address

2305 Historic Decatur Rd Ste 100
San Diego, CA 92106-6071

Phone

(619) 354-2682

Fax

(619) 839-3780

NPI assigned

Jan 27, 2016

Organization subpart

No

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

Authorized official

Name

Jodi L Ceballos, PSY.D.

Title

Licensed Clinical Psychologist

Phone

(619) 354-2682

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1453852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1427415967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 HISTORIC DECATUR RD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066071",
            "telephone_number": "619-354-2682",
            "fax_number": "619-839-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 HISTORIC DECATUR RD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066071",
            "telephone_number": "619-354-2682",
            "fax_number": "619-839-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MIND & BODY PSYCHOTHERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-27",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "CEBALLOS",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "619-354-2682",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY26623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.