Individual provider Active NPI

Alejandro Corona Espinosa, PH.D., HSPP

  • Clinical Psychologist
  • South Bend, IN
National Provider Identifier
1649904996
Registry record updated Sep 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20043909B Issued in IN
Practice address
3220 E Jefferson Blvd
South Bend, IN 46615-3028
Phone
(574) 222-2466
NPI assigned
Jul 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 20043909B IN
Clinical Psychologist 103TC0700X 20043909B IN Primary

Addresses

Primary practice location

3220 E Jefferson Blvd
South Bend, IN 46615-3028

Mailing address

52266 Tammy Dr
Granger, IN 46530-9588
Phone (716) 908-9559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903004065 IN Practitioner - Clinical Psychologist 4688113764 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20043909BINMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Reflections Counseling CurrentSince Aug 5, 2024 Accepting new patients
Dr Heather Holleman LLC Clinical CurrentSince Aug 5, 2024 Accepting new patients

Locations

3220 E Jefferson Blvd
South Bend, IN 46615
Phone (574) 222-2466

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758412800000",
    "number": "1649904996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52266 TAMMY DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309588",
            "telephone_number": "716-908-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466153028",
            "telephone_number": "574-222-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORONA ESPINOSA",
        "first_name": "ALEJANDRO",
        "credential": "PH.D., HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-13",
        "last_updated": "2025-09-21",
        "certification_date": "2025-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20043909B",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043909B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.