Takisha M Corbett, PHD

Primary specialty

Health PsychologistTaxonomy code 103TH0004X

License

31413 Issued in CA

Practice address

1901 1St Avenue Ste 245
San Diego, CA 92101-9210

Phone

(858) 964-0722

NPI assigned

Sep 13, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Takisha M McNeill Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Neurobehavioral Clinic IncGroup PAC ID 9234454422, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Pacific Neurobehavioral Clinic: a Psychological Corporation

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1952724817
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1750631065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "address_2": "STE 245",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921010311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 1ST AVENUE STE 245",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921019210",
            "telephone_number": "858-964-0722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 E 120th St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900593052",
            "country_code": "US",
            "telephone_number": "310-668-8119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8950 Villa La Jolla Dr",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371714",
            "country_code": "US",
            "telephone_number": "858-534-2230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORBETT",
        "first_name": "TAKISHA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-13",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "CA",
            "license": "31413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAKISHA",
            "last_name": "MCNEILL",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donna Christine Corbett, PSY.D.
• Forest Corbett
• Julia Corbett
• Kimberly Fara Corbett, PSYD, MFT
• Stephanie Lynn Corbett, CRNA
• Shalaine Brooke Corbilla, DNP, FNP-BC
• Corbin Smith DMD Dental Corp.
• Ann Corbin-Fulchiron, LCSW, CADC-II
• Dawn Michelle Corbin
• Heather Sachiko Corbin

• Health Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Health Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.