NPIMap

Organization Active NPI

Wandering Collective LLC

  • Clinical Psychologist
  • Sacramento, CA
National Provider Identifier
1679176937
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
WANDERING COLLECTIVE LLC
Practice address
5960 S Land Park Dr # 1194
Sacramento, CA 95822-3313
Phone
(404) 895-6416
NPI assigned
Nov 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Emily Fortney, PSY.D.NPI 1821608613
Title
Owner
Phone
(404) 895-6416

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 Primary

Addresses

Primary practice location

5960 S Land Park Dr # 1194
Sacramento, CA 95822-3313

Mailing address

2514 Amelia Earhart Ave
Sacramento, CA 95834-4003
Phone (404) 895-6416

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address emily.fortney@therapysecure.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1679176937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 AMELIA EARHART AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958344003",
            "telephone_number": "404-895-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960 S LAND PARK DR # 1194",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958223313",
            "telephone_number": "404-895-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDERING COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "FORTNEY",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-895-6416",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emily.fortney@therapysecure.com",
            "affiliation": "N",
            "endpointDescription": "Hushmail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "2514 Amelia Earhart Ave",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958344003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.