Organization Active NPI

Susan L Holley PHD, a Psychological Corporation

  • Clinical Psychologist
  • Tehachapi, CA
National Provider Identifier
1598955239
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUSAN L HOLLEY PHD, A PSYCHOLOGICAL CORPORATION
Practice address
798 Tucker Rd Ste 1
Tehachapi, CA 93561-2503
Phone
(661) 206-8108
Fax
(661) 821-9752
NPI assigned
Jul 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Susan Louise Holley, PHDNPI 1124056270
Title
Licensed Clinical Psychologist
Phone
(661) 206-8108

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

798 Tucker Rd Ste 1
Tehachapi, CA 93561-2503

Mailing address

798 Tucker Rd Ste 1
Tehachapi, CA 93561-2503
Phone (661) 206-8108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080418000342 CA Part B Supplier - Clinic/Group Practice 4688752462 Receives reassigned benefits from 1 practitioner
Practice locations: Temecula, CA

National Provider Directory

National Provider Directory

Locations

43535 17th St W
Ste 304
Lancaster, CA 93534
Phone (661) 722-9556

39959 Sierra Hwy
Ste A130
Palmdale, CA 93550
Phone (661) 206-8108

798 Tucker Rd
Ste 1
Tehachapi, CA 93561
Phone (661) 206-8108

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1598955239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "798 TUCKER RD STE 1",
            "city": "TEHACHAPI",
            "state": "CA",
            "postal_code": "935612503",
            "telephone_number": "661-206-8108",
            "fax_number": "661-821-9752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "798 TUCKER RD STE 1",
            "city": "TEHACHAPI",
            "state": "CA",
            "postal_code": "935612503",
            "telephone_number": "661-206-8108",
            "fax_number": "661-821-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN L HOLLEY PHD, A PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "661-206-8108",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tehachapi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.