DR. TARA FAIRBANKS (NPI# 1750781118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750781118 |
| Entity Type | Individual |
| Full Name | DR. TARA FAIRBANKS |
| Practice Address |
3301 Ocean Park Blvd Ste 210 Santa Monica CA 90405-3230 |
| Practice Telephone | 3237619591 |
| Mailing Telephone | 3237619591 |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2020-10-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 32174 | CA | Behavioral Health & Social Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 7068 | 05 | |
| CA | 7420 | 05 | |
| CA | 6758 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 12450 Van Nuys Blvd, Suite 200, Pacoima, CA 913311391 | 8188961161 | 8188965069 |
| Street Address |
3301 OCEAN PARK BLVD STE 210 |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90405-3230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043588775 | Timothy Kenji Wong | Psychologist | 3301 Ocean Park Blvd Ste 210, Santa Monica, CA 90405-3230 | 2011-12-08 |
| 1962967372 | Santa Monica Therapy, A Psychology Corporation | Psychologist | 3301 Ocean Park Blvd Ste 210, Santa Monica, CA 90405-3230 | 2019-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699328476 | Nicole Ryan Harbeck | Marriage & Family Therapist | 2716 Ocean Park Blvd Ste 2007, Santa Monica, CA 90405 | 2019-07-19 |
| 1922664440 | Betty Ann Wise | Counselor | 1865 W. 9th Street, Santa Monica, CA 90405 | 2019-05-10 |
| 1790203776 | Ernest Jones Jr. | Counselor | 909 Pico Blvd., Santa Monica, CA 90405 | 2017-08-30 |
| 1285171371 | Jori Adler Marriage & Family Therapy Prof. Corp. | Marriage & Family Therapist | 3400 Airport Ave Ste 30, Santa Monica, CA 90405 | 2017-01-26 |
| 1376993147 | Damoan Corp. | Speech-Language Pathologist | 2801 Ocean Park Blvd Ste 393, Santa Monica, CA 90405 | 2016-06-13 |
| 1427410034 | Adam Rubio | Clinical Neuropsychologist | 1916 4th Street, Santa Monica, CA 90405 | 2016-03-23 |
| 1760852842 | Yramnna Smith | Behavioral Analyst | 2716 Ocean Park Blvd Ste 1025, Santa Monica, CA 90405 | 2015-10-01 |
| 1689086076 | Cheryl K. Baker | Community Health Worker | 1750 Ocean Park Blvd., Suite 206, Santa Monica, CA 90405 | 2014-05-20 |
| 1629409891 | Dominique M. Delvecchio | Nurse Practitioner | 2716 Ocean Park Blvd. Suite 3082, Institute for Nerve Medicine, Santa Monica, CA 90405 | 2013-12-12 |
| 1639512692 | Nancy Elizabeth Hyland | Marriage & Family Therapist | 1720 Ocean Park Blvd, Suite 200a, Santa Monica, CA 90405 | 2013-04-09 |
| Find all providers in zip 90405 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033750468 | Erin Margolis | Psychologist | 1247 7th St Ste 200, Santa Monica, CA 90401-1660 | 2019-10-07 |
| 1063066132 | Lena Harris | Psychologist | 185 Pier Ave Ste 109, Santa Monica, CA 90405-5358 | 2019-07-27 |
| 1992364905 | Elisa Leal | Psychologist | 1831 Stanford St Ste 108, Santa Monica, CA 90404-4117 | 2019-06-12 |
| 1538628243 | Joanna M Ceppi | Psychologist | 2811 Wilshire Blvd Ste 660, Santa Monica, CA 90403-4823 | 2019-03-13 |
| 1013492388 | Gideon Psychology, PC | Psychologist | 1137 2nd St Ste 216, Santa Monica, CA 90403-5077 | 2018-10-02 |
| 1932615846 | Beth Levy | Psychologist | 3435 Ocean Park Blvd Ste 211, Santa Monica, CA 90405-3315 | 2017-12-15 |
| 1932633302 | Brenda Heidrich | Psychologist | 270 26th St Ste 202, Santa Monica, CA 90402-2543 | 2017-04-12 |
| 1972052694 | Lisa Burklund | Psychologist | 429 Santa Monica Blvd Ste 460, Santa Monica, CA 90401-3455 | 2016-09-22 |
| 1265987861 | Diana Devilliers | Psychologist | 138 Bicknell Ave, Santa Monica, CA 90405-2221 | 2016-08-24 |
| 1205212420 | Anna Selena Cho | Psychologist | 169 Pier Ave., Suite 5, Santa Monica, CA 90405-5311 | 2015-08-11 |
| Find all providers in SANTA MONICA | ||||
| City | SANTA MONICA |
| Zip Code | 90405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.