The Therapy Couch by Jennyfer Peterson Psychologist Inc

Key facts

NPI: 1760173884
Entity type: Organization (NPI type 2)
Primary specialty: Psychologist 103T00000X
Legal business name: THE THERAPY COUCH BY JENNYFER PETERSON PSYCHOLOGIST INC
Practice address: 235 Montana del Lago Dr
RSM, CA 92688-1361
Phone: (949) 394-4049
NPI assigned: May 18, 2023
Organization subpart: No

Authorized official

Name: Jenyffer Peterson NPI 1760734032
Title: Ceo
Phone: (949) 394-4049

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jenyffer Peterson Clinical Psychologist · Rancho Santa Margarita, CA · NPI 1760734032

Medicare reassignment NPD Authorized official CA · CLINICAL

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20231222002187	CA	Part B Supplier - Clinic/Group Practice	9931566775	Receives reassigned benefits from 1 practitioner Practice locations: Rancho Santa Margarita, CA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	Primary
Psychologist Group: 193200000X MULTI-SPECIALTY GROUP	103T00000X	Yes
Clinical Psychologist Group: 193200000X MULTI-SPECIALTY GROUP	103TC0700X
Social Worker Group: 193200000X MULTI-SPECIALTY GROUP	104100000X

Addresses

Primary practice location

235 Montana del Lago Dr
RSM, CA 92688-1361

Mailing address

235 Montana del Lago Dr
RSM, CA 92688-1361
Phone (949) 394-4049

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 19, 2023.

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1760173884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 MONTANA DEL LAGO DR",
            "city": "RSM",
            "state": "CA",
            "postal_code": "926881361",
            "telephone_number": "949-394-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 MONTANA DEL LAGO DR",
            "city": "RSM",
            "state": "CA",
            "postal_code": "926881361",
            "telephone_number": "949-394-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE THERAPY COUCH BY JENNYFER PETERSON PSYCHOLOGIST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JENYFFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-394-4049"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in RSM, CA

All providers in RSM, CA · Psychologist in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.