Active NPI
Line Brynjulfsen, PH.D.
- Clinical Psychologist
- Coalinga, CA
National Provider Identifier
1609064534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 21041
- Practice address
- 24511 West Jayne Ave.
Coalinga State Hospital
Coalinga, CA 93210-5003 - Phone
- (559) 934-3088
- NPI assigned
- Oct 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY 21041 | CA | Primary |
Addresses
Primary practice location
24511 West Jayne Ave.
Coalinga State Hospital
Coalinga, CA 93210-5003
Mailing address
PO Box 5003
24511 West Jayne Ave.
Coalinga, CA 93210-5003
Phone (559) 934-3088
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 21041 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191456000000",
"number": "1609064534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5003",
"address_2": "24511 WEST JAYNE AVE.",
"city": "COALINGA",
"state": "CA",
"postal_code": "932105003",
"telephone_number": "559-934-3088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24511 WEST JAYNE AVE.",
"address_2": "COALINGA STATE HOSPITAL",
"city": "COALINGA",
"state": "CA",
"postal_code": "932105003",
"telephone_number": "559-934-3088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYNJULFSEN",
"first_name": "LINE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-04",
"last_updated": "2007-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 21041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coalinga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.