Courtney Crisp

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY34196 Issued in CA

Practice address

11835 W Olympic Blvd Ste 1270E
Los Angeles, CA 90064-5053

Phone

(310) 273-4843

Fax

(310) 273-5056

NPI assigned

Aug 23, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Executive Mental Health, IncGroup PAC ID 0345209102, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Executive Mental Health, Inc.

  • Mental Health Counselor
  • Los Angeles, CA
  • NPI 1275670036
  Medicare reassignment Care Compare group
• Brian Wu MD PHD Inc

  • Psychiatry Physician
  • San Gabriel, CA
  • NPI 1528639481
  NPD

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

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1902680564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 W OLYMPIC BLVD STE 1270E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900645053",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 W OLYMPIC BLVD STE 1270E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900645053",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISP",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY34196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Crismond Anaya, LCSW
• Elaine Yvette Crisostomo-Verdugo, MSW, ACSW
• Rhea Laron Crisostomo, NP
• Rowena Dimapilis Crisostomo
• Brooke Crisp, MD
• Matthew Grant Crisp
• Rio Criss
• Myndy Crist, LMFT
• Cristian Center Manor Alcohol and Drug Behavior Center
• Christian Cristiano, M.S.

• Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.