=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780397414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA PSYCHOLOGY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2022
-----------------------------------------------------
Last Update Date | 12/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11440 W BERNARDO CT STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-790-8810
-----------------------------------------------------
Fax | 855-965-4080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11440 W BERNARDO CT STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-790-8810
-----------------------------------------------------
Fax | 855-965-4080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST, CEO
-----------------------------------------------------
Name | DR. APRIL MINJAREZ
-----------------------------------------------------
Credential | PHD, LMFT
-----------------------------------------------------
Telephone | 858-790-8810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------