NPIMap

Organization Active NPI

Performance Psychology Center

  • Mental Health Counselor
  • Santa Rosa, CA
National Provider Identifier
1982485413
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PERFORMANCE PSYCHOLOGY CENTER
Practice address
2455 Bennett Valley Rd Ste B208
Santa Rosa, CA 95404-5667
Phone
(707) 583-9663
NPI assigned
Oct 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Joseph Puentes, PSY.D.NPI 1568806560
Title
Psychologist, Owner
Phone
(707) 583-9663

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
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2455 Bennett Valley Rd Ste B208
Santa Rosa, CA 95404-5667

Mailing address

2455 Bennett Valley Rd Ste B208
Santa Rosa, CA 95404-5667

National Provider Directory

National Provider Directory

Locations

2455 Bennett Valley Rd
Ste B208
Santa Rosa, CA 95404
Phone (707) 477-6594

Practitioners & affiliated clinicians

Practitioners 6

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": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1982485413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 BENNETT VALLEY RD STE B208",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 BENNETT VALLEY RD STE B208",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045667",
            "telephone_number": "707-583-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PSYCHOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "PUENTES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PSYCHOLOGIST, OWNER",
        "authorized_official_telephone_number": "707-583-9663",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.