Soul Tide Psychotherapy PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

SOUL TIDE PSYCHOTHERAPY PC

Practice address

3257 Camino de Los Coches
Carlsbad, CA 92009-8976

Phone

(858) 945-7421

NPI assigned

Apr 29, 2025

Organization subpart

No

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

Authorized official

Name

Trevor Olson, PSY.D.NPI 1972956373

Title

Secretary

Phone

(858) 945-7421

Specialties & licenses 10

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trevor Olson, PSY.D.

  • Clinical Psychologist
  • La Jolla, CA
  • NPI 1972956373
  Medicare reassignment Care Compare group NPD Authorized official
• Jessica Story Anderson

  • Clinical Social Worker
  • San Diego, CA
  • NPI 1710639869
  Medicare reassignment Care Compare group NPD
• Lizzette Vescera, LMFT

  • Marriage & Family Therapist
  • Carlsbad, CA
  • NPI 1063670586
  Medicare reassignment

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

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1528856531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 IRVING AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132301",
            "telephone_number": "858-945-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3257 CAMINO DE LOS COCHES",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920098976",
            "telephone_number": "858-945-7421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL TIDE PSYCHOTHERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "858-945-7421",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makayla Soto
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• Jennifer Anne Souders, D.PT.
• Soul Shining Psychology Professional Corporation
• Soul Tide Outpatient Psychotherapy, PC
• Southcoast Psychological Associates, Inc.
• Southern California Institute of Clinical Nutrition
• Southern California Recovery Centers Oceanside LLC
• Itzamara Sparks
• Michelle Yennhi Spatz

• Clinical Psychologist in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.