Icon Behavioral and Mental Healthcare Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ICON BEHAVIORAL AND MENTAL HEALTHCARE INC

Practice address

9087 Arrow Rte Ste 265
Rancho Cucamonga, CA 91730-4487

Phone

(909) 351-4441

Fax

(909) 351-4411

NPI assigned

Sep 20, 2022

Organization subpart

No

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

Authorized official

Name

Bernice Ivoko, NP

Title

Owner

Phone

(909) 351-4441

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1740903293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9087 ARROW RTE STE 265",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304487",
            "telephone_number": "909-351-4441",
            "fax_number": "909-351-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9087 ARROW RTE STE 265",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304487",
            "telephone_number": "909-351-4441",
            "fax_number": "909-351-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON BEHAVIORAL AND MENTAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "IVOKO",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-351-4441",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.