NPIMap

Organization Active NPI

California Mental Health and Psychology Center Inc

  • Clinical Psychologist
  • Fresno, CA
National Provider Identifier
1689406688
Registry record updated Aug 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CALIFORNIA MENTAL HEALTH AND PSYCHOLOGY CENTER INC
Practice address
1141 W Shaw Ave Ste 203
Fresno, CA 93711-3713
Phone
(559) 720-9003
NPI assigned
Aug 17, 2024
Last updated
Aug 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2024

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

Authorized official

Name
Jaylene Booth
Title
Billing
Phone
(805) 441-8398

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

1141 W Shaw Ave Ste 203
Fresno, CA 93711-3713

Mailing address

2603 E Deyoung Dr
Fresno, CA 93720-4468
Phone (559) 720-9003

Other names 1

  • MOTO FUJII PSYD Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240911002259 CA Part B Supplier - Clinic/Group Practice 7113467622 Receives reassigned benefits from 1 practitioner
Practice locations: Fresno, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1723852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723852800000",
    "number": "1689406688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 E DEYOUNG DR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937204468",
            "telephone_number": "559-720-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 W SHAW AVE STE 203",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113713",
            "telephone_number": "559-720-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA MENTAL HEALTH AND PSYCHOLOGY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-17",
        "last_updated": "2024-08-17",
        "certification_date": "2024-08-17",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "JAYLENE",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "805-441-8398"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOTO FUJII PSYD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.