NPIMap

Organization Active NPI

Pacific Forensic Psychology Associates, Inc

Doing business as Elysian Health Partners

  • Adult Mental Health Clinic/Center
  • Sonoma, CA
National Provider Identifier
1790325694
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES, INC
Doing business as
Elysian Health Partners
Practice address
19230 Sonoma Highway
Building 200
Sonoma, CA 95476
Phone
(916) 224-0212
NPI assigned
Jan 9, 2020
Last updated
Jan 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Dr. Tony Angelo, PSY.D.
Title
President / Principle
Phone
(707) 395-4500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Cognitive & Behavioral Psychologist 103TB0200X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

19230 Sonoma Highway
Building 200
Sonoma, CA 95476

Mailing address

19230 Sonoma Highway
Building 200
Sonoma, CA 95476
Phone (916) 224-0212

Other names 1

  • Elysian Health Partners Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pacific Forensic Psychology Associates Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1790325694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19230 SONOMA HIGHWAY",
            "address_2": "BUILDING 200",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "95476",
            "telephone_number": "916-224-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19230 SONOMA HIGHWAY",
            "address_2": "BUILDING 200",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "95476",
            "telephone_number": "916-224-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "ANGELO",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "PRESIDENT / PRINCIPLE",
        "authorized_official_telephone_number": "707-395-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elysian Health Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonoma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; 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.