Organization Active NPI

Kairos Psychology PC

  • Clinical Psychologist
  • Vacaville, CA
National Provider Identifier
1629410022
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY21927 Issued in CA
Legal business name
KAIROS PSYCHOLOGY PC
Practice address
790 Mason St Ste 102
Vacaville, CA 95688-4661
Phone
(707) 874-8463
Fax
(707) 455-6026
NPI assigned
Jul 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
Dr. Phillip James AtkinsonNPI 1487828620
Title
Clinical Director
Phone
(707) 874-8463

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 PSY21927 CA Primary

Addresses

Primary practice location

790 Mason St Ste 102
Vacaville, CA 95688-4661

Mailing address

790 Mason St Ste 102
Vacaville, CA 95688-4661
Phone (707) 874-8463

Other names 1

  • Kairos Counseling Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211227001329 CA Part B Supplier - Clinic/Group Practice 3870984925 Receives reassigned benefits from 5 practitioners
Practice locations: Vacaville, CA

National Provider Directory

National Provider Directory

Locations

790 Mason St
Ste 102
Vacaville, CA 95688
Phone (707) 335-4209

5063 Maple Rd
Ste 100
Vacaville, CA 95687

5063 Maple Rd
Vacaville, CA 95687
Phone (540) 993-3422

Practitioners & affiliated clinicians

Practitioners 12

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": "1374710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1629410022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 MASON ST STE 102",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956884661",
            "telephone_number": "707-874-8463",
            "fax_number": "707-455-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 MASON ST STE 102",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956884661",
            "telephone_number": "707-874-8463",
            "fax_number": "707-455-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIROS PSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-25",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "ATKINSON",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "707-874-8463",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kairos Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kairos Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vacaville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.