Organization Active NPI

Sacred Tree Psychotherapy PC

  • Clinical Psychologist
  • El Cajon, CA
National Provider Identifier
1922710029
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SACRED TREE PSYCHOTHERAPY PC
Practice address
411 S Magnolia Ave
El Cajon, CA 92020-5212
Phone
(619) 333-6574
NPI assigned
Dec 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Authorized official

Name
Dr. Amanda Zora, PSYDNPI 1457729485
Title
Clinical Psychologist/Ceo
Phone
(619) 333-6574

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: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

411 S Magnolia Ave
El Cajon, CA 92020-5212

Mailing address

411 S Magnolia Ave
El Cajon, CA 92020-5212
Phone (619) 938-4108

Other names 1

  • Sacred Tree Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230208001798 CA Part B Supplier - Clinic/Group Practice 9234501867 Receives reassigned benefits from 1 practitioner
Practice locations: El Cajon, CA

National Provider Directory

National Provider Directory

Locations

1530 Jamacha Rd
Ste X
El Cajon, CA 92019
Phone (619) 333-6574

Practitioners & affiliated clinicians

Practitioners 1

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": "1671494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1922710029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 S MAGNOLIA AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205212",
            "telephone_number": "619-938-4108",
            "fax_number": "619-332-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 S MAGNOLIA AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205212",
            "telephone_number": "619-333-6574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED TREE PSYCHOTHERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-20",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "ZORA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/CEO",
        "authorized_official_telephone_number": "619-333-6574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacred Tree Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Cajon, CA

Sources for this page

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