NPIMap

Organization Active NPI

Psych Lab Psychology, Inc.

Doing business as Psych Lab

  • Clinical Psychologist
  • Long Beach, CA
National Provider Identifier
1811452196
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PSYCH LAB PSYCHOLOGY, INC.
Doing business as
Psych Lab
Practice address
3950 Long Beach Blvd Ste 101
Long Beach, CA 90807-5410
Phone
(562) 684-1300
Fax
(562) 684-1301
NPI assigned
Jan 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Dr. David Godot, PSYDNPI 1679941256
Title
Ceo
Phone
(562) 684-1305

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

3950 Long Beach Blvd Ste 101
Long Beach, CA 90807-5410

Mailing address

5150 E Pacific Coast Hwy Ste 200
Long Beach, CA 90804-3399
Phone (323) 942-9668

Other names 1

  • Psych Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200602000696 CA Part B Supplier - Clinic/Group Practice 4880015791 Receives reassigned benefits from 5 practitioners
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1811452196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 E PACIFIC COAST HWY STE 200",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908043399",
            "telephone_number": "323-942-9668",
            "fax_number": "323-400-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 LONG BEACH BLVD STE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075410",
            "telephone_number": "562-684-1300",
            "fax_number": "562-684-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCH LAB PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "GODOT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-684-1305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psych Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Psych Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare 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.