Active NPI
Jacqueline Fakhoury, PSY.D.
- Clinical Psychologist
- Corcoran, CA
National Provider Identifier
1598045783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29080
- Practice address
- 4001 King Ave
Corcoran, CA 93212-9611 - Phone
- (559) 992-8800
- NPI assigned
- Aug 19, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29080 | CA | Primary |
Addresses
Primary practice location
4001 King Ave
Corcoran, CA 93212-9611
Mailing address
PO Box 6724
Visalia, CA 93290-6724
Phone (818) 489-6056
Other practice location 1
3580 Wilshire Blvd. Ste. 2000
I.M.C.E.S.
Los Angeles, CA 90010
Phone (213) 381-1250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29080 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corrections and Rehabilitation-Headquarters | Current | Accepting new patients | |
| CSP-Corcoran | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Corcoran, CA
- NPI 1376190876
-
- Case Management Agency
- Corcoran, CA
- NPI 1265772198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583712000000",
"number": "1598045783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6724",
"city": "VISALIA",
"state": "CA",
"postal_code": "932906724",
"telephone_number": "818-489-6056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 KING AVE",
"city": "CORCORAN",
"state": "CA",
"postal_code": "932129611",
"telephone_number": "559-992-8800"
}
],
"practiceLocations": [
{
"address_1": "3580 Wilshire Blvd. Ste. 2000",
"address_2": "I.M.C.E.S.",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "90010",
"country_code": "US",
"telephone_number": "213-381-1250",
"fax_number": "213-383-4803",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FAKHOURY",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-19",
"last_updated": "2020-03-09",
"certification_date": "2020-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corcoran, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.