Active NPI
Irina Koll, PSY.D
- Psychologist
- Pacoima, CA
National Provider Identifier
1770922916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSB94025992
- Practice address
- 12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393 - Phone
- (818) 896-1161
- Fax
- (818) 896-5069
- NPI assigned
- Jun 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Counselor | 225C00000X | |||
| Psychologist | 103T00000X | PSB94025992 | CA | Primary |
Addresses
Primary practice location
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Mailing address
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Phone (818) 896-1161
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6758 | Medicaid | CA | |
| 7420 | Medicaid | CA | |
| 7068 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB94025992 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellqor Psychological Services of California, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Murrieta, CA
- NPI 1093173742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1770922916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161",
"fax_number": "818-896-5069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161",
"fax_number": "818-896-5069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLL",
"first_name": "IRINA",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-20",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225C00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSB94025992",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6758",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7420",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7068",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacoima, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.