Provider Demographics
NPI:1235940115
Name:COHERENT MIND PSYCHOLOGY , PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:COHERENT MIND PSYCHOLOGY , PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-723-3378
Mailing Address - Street 1:619 S VULCAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3653
Mailing Address - Country:US
Mailing Address - Phone:619-723-3378
Mailing Address - Fax:
Practice Address - Street 1:619 S VULCAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3653
Practice Address - Country:US
Practice Address - Phone:619-723-3378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)