Healthcare Provider Details

I. General information

NPI: 1558291724
Provider Name (Legal Business Name): LIGHTSPEED PSYCHOLOGY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13728 SOMERSET RD
POWAY CA
92064-4037
US

IV. Provider business mailing address

14781 POMERADO RD # 62
POWAY CA
92064-2802
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-7083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GINGER BURLESON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 949-557-7083