Provider Demographics
NPI:1821122318
Name:THE COGNITIVE THERAPY INSTITUTE, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:THE COGNITIVE THERAPY INSTITUTE, A PSYCHOLOGICAL CORPORATION
Other - Org Name:THE COGNITIVE THERAPY INSTITUTE OF SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHENK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-450-1101
Mailing Address - Street 1:3262 HOLIDAY CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0026
Mailing Address - Country:US
Mailing Address - Phone:858-450-1101
Mailing Address - Fax:858-450-1161
Practice Address - Street 1:3262 HOLIDAY CT
Practice Address - Street 2:SUITE 220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0026
Practice Address - Country:US
Practice Address - Phone:858-450-1101
Practice Address - Fax:858-450-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TP2701X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTRICARE, TRIWEST
CA=========OtherTRICARE, TRIWEST