NPIMap

Organization Active NPI

TLC Family Therapy Corp

Doing business as San Diego Medical Pain and Trama Institute

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1629692397
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
TLC FAMILY THERAPY CORP
Doing business as
San Diego Medical Pain and Trama Institute
TLC Family Therapy Corp
Practice address
5405 Morehouse Dr Ste 120
San Diego, CA 92121-4723
Phone
(442) 777-2040
Fax
(858) 408-4494
NPI assigned
May 29, 2020
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Tracey Lynn Chester, LMFTNPI 1740549658
Title
Founder/Clinical Director
Phone
(858) 531-3795

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
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

5405 Morehouse Dr Ste 120
San Diego, CA 92121-4723

Mailing address

5965 Village Way. Suite 105 #112
San Diego, CA 92130
Phone (442) 777-2040

Other names 2

  • San Diego Medical Pain and Trama Institute Doing business as
  • TLC Family Therapy Corp Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210428002223 CA Part B Supplier - Clinic/Group Practice 6305254590 Receives reassigned benefits from 7 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

5965 Village Way
Ste 105
San Diego, CA 92130

5965 Village Way
Ste 112
San Diego, CA 92130

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1629692397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5965 VILLAGE WAY. SUITE 105 #112",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130",
            "telephone_number": "442-777-2040",
            "fax_number": "858-408-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 MOREHOUSE DR STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214723",
            "telephone_number": "442-777-2040",
            "fax_number": "858-408-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC FAMILY THERAPY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-29",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "CHESTER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "FOUNDER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "858-531-3795",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego Medical Pain and Trama Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TLC Family Therapy Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.