NPIMap

Organization Active NPI

Psychserves

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1831464742
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY23509 Issued in CA
Legal business name
PSYCHSERVES
Practice address
626 Wilshire Blvd
910
Los Angeles, CA 90017-3209
Phone
(949) 331-4559
Fax
(312) 622-5633
NPI assigned
Mar 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Authorized official

Name
Dr. Shaelyn T. Pham, PH.DNPI 1902073711
Title
Ceo
Phone
(949) 331-4559

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 PSY23509 CA Primary

Addresses

Primary practice location

626 Wilshire Blvd
910
Los Angeles, CA 90017-3209

Mailing address

626 Wilshire Blvd
910
Los Angeles, CA 90017-3209
Phone (949) 331-4559

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1831464742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 WILSHIRE BLVD",
            "address_2": "910",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900173209",
            "telephone_number": "949-331-4559",
            "fax_number": "312-622-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 WILSHIRE BLVD",
            "address_2": "910",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900173209",
            "telephone_number": "949-331-4559",
            "fax_number": "312-622-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHSERVES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-12",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "SHAELYN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-331-4559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.

Verify at the official NPI Registry.