Psychological Enrichment Center

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY18437 Issued in CA

Legal business name

PSYCHOLOGICAL ENRICHMENT CENTER

Practice address

2900 Bristol St
Suite A108
Costa Mesa, CA 92626-5981

Phone

(714) 432-0042

NPI assigned

Jul 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul Sullivan, PSY.D.NPI 1689873994

Title

President/Psychologist

Phone

(714) 432-0042

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Paul Sullivan, PSY.D.

  • Clinical Psychologist
  • Costa Mesa, CA
  • NPI 1689873994
  NPD (past) Authorized official
• Stacey Aoto-Sullivan, PSY.D.

  • Clinical Psychologist
  • Costa Mesa, CA
  • NPI 1952500266
  NPD (past)
• Jay Gattis, PSY.D.

  • Clinical Psychologist
  • Costa Mesa, CA
  • NPI 1104072610
  NPD (past)

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1942409255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST",
            "address_2": "SUITE A108",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265981",
            "telephone_number": "714-432-0042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST",
            "address_2": "SUITE A108",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265981",
            "telephone_number": "714-432-0042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL ENRICHMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT/PSYCHOLOGIST",
        "authorized_official_telephone_number": "714-432-0042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychogenesis Detox Center
• Psychological Health Associates
• Donjanea Shaprea Pugh
• Isabel Soledad Pulido, EMT
• Pulmo Test, Inc.
• Brandi Nicole Pulsifer

• Clinical Psychologist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.