Mellow Psychological Services, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY23911 Issued in CA

Legal business name

MELLOW PSYCHOLOGICAL SERVICES, INC.

Practice address

200 Pier Ave
Suite 424
Hermosa Beach, CA 90254-3608

Phone

(800) 593-2560

Fax

(800) 593-2560

NPI assigned

Aug 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Colleen F. Long, PSY.D.

Title

Owner

Phone

(800) 593-2560

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1344038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344038400000",
    "number": "1457608804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PIER AVE",
            "address_2": "SUITE 424",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543608",
            "telephone_number": "800-593-2560",
            "fax_number": "800-593-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PIER AVE",
            "address_2": "SUITE 424",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543608",
            "telephone_number": "800-593-2560",
            "fax_number": "800-593-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELLOW PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-04",
        "last_updated": "2012-08-04",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-593-2560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Hermosa Beach, CA
• Providers in Hermosa Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2012; 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.