Well Street Psychological Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15533 Issued in CA

Legal business name

WELL STREET PSYCHOLOGICAL INC.

Practice address

100 S Imperial Hwy
Anaheim, CA 92807-3943

Phone

(714) 730-9355

Fax

(714) 730-9355

NPI assigned

Aug 6, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Martin J Eaton, PH.DNPI 1134221252

Title

Ceo/Owner

Phone

(714) 730-9355

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Martin John Eaton, PH.D.

  • Psychologist
  • Tustin, CA
  • NPI 1134221252
  NPD (past) Authorized official

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470441600000",
    "number": "1760936835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S IMPERIAL HWY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928073943",
            "telephone_number": "714-730-9355",
            "fax_number": "714-730-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S IMPERIAL HWY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928073943",
            "telephone_number": "714-730-9355",
            "fax_number": "714-730-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL STREET PSYCHOLOGICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-08-06",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "714-730-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY15533",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15533",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY15533",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY15533",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE",
            "identifier": "PSY15533",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Welsh

• Clinical Psychologist in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2016; 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.