The Undiscovered Self, PC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

THE UNDISCOVERED SELF, PC

Practice address

1015 W Hays St Ste 205
Boise, ID 83702-5412

Phone

(310) 500-6862

NPI assigned

Nov 14, 2025

Last updated

Nov 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Anthony Beradino, PHDNPI 1679819627

Title

Psychologist

Phone

(310) 500-6862

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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.

• John Anthony Beradino Jr., M.A.

  • Mental Health Counselor
  • Sherman Oaks, CA
  • NPI 1679819627

  ID

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1763078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1487514212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 E WARM SPRINGS AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837128025",
            "telephone_number": "310-500-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W HAYS ST STE 205",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025412",
            "telephone_number": "310-500-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE UNDISCOVERED SELF, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-14",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A",
        "authorized_official_last_name": "BERADINO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "310-500-6862",
        "authorized_official_name_prefix": "Dr.",
        "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": []
}

• The PT Next Door
• The Red Fox Group
• The Regents of the University of Idaho
• The Shoulder Clinic of Idaho PLLC
• The Spaulding Home LLC
• The Village Charter School, Inc.
• The Young Mens Christian Association of Boise City Idaho (Treasure Valley Family YMCA)
• Kristine Lynn Theis, NP
• Therapeutic Associates Inc (TAI Boise Physical Therapy State Street)
• Therapeutic Associates Inc (TAI SE Boise)

• Psychologist in Boise, ID
• Providers in Boise, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.