Doulos Community Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12904 Issued in CA

Legal business name

DOULOS COMMUNITY SERVICES

Practice address

9640 Center Ave
Suite 120
Rancho Cucamonga, CA 91730-5809

Phone

(909) 996-7892

NPI assigned

Nov 20, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Catherine Marie Cook

Title

Secretary Office Manager

Phone

(909) 996-7892

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1629408190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9640 CENTER AVE",
            "address_2": "SUITE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305809",
            "telephone_number": "909-996-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9640 CENTER AVE",
            "address_2": "SUITE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305809",
            "telephone_number": "909-996-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOULOS COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "SECRETARY OFFICE MANAGER",
        "authorized_official_telephone_number": "909-996-7892",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12904",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC39894",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "OPL129041",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.