Empowered Living Psychological Services, Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

EMPOWERED LIVING PSYCHOLOGICAL SERVICES, INC.

Practice address

9113 Foothill Blvd Ste 130
Rancho Cucamonga, CA 91730-6565

Phone

(909) 652-0361

Fax

(909) 652-0241

NPI assigned

Jan 22, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Stefanie Lockhart-Pettaway, PSY.DNPI 1497934871

Title

Ceo/ Clinical Psychologist

Phone

(909) 652-0361

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Stefanie Lockhart-Pettaway, PSY.D, MSW

  • Psychologist
  • Rancho Cucamonga, CA
  • NPI 1497934871
  NPD (past) Authorized official

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1831653021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9113 FOOTHILL BLVD STE 130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306565",
            "telephone_number": "909-652-0361",
            "fax_number": "909-652-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9113 FOOTHILL BLVD STE 130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306565",
            "telephone_number": "909-652-0361",
            "fax_number": "909-652-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERED LIVING PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "LOCKHART-PETTAWAY",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "CEO/ CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "909-652-0361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.