Provider Demographics
NPI:1912662313
Name:COLLECTIVE CONSCIOUSNESS OF NEW AGE NATIVE AMERICANS
Entity Type:Organization
Organization Name:COLLECTIVE CONSCIOUSNESS OF NEW AGE NATIVE AMERICANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:TASHEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-HAYSELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PSYD
Authorized Official - Phone:619-738-4017
Mailing Address - Street 1:3860 MURPHY CANYON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4403
Mailing Address - Country:US
Mailing Address - Phone:619-738-4017
Mailing Address - Fax:
Practice Address - Street 1:3860 MURPHY CANYON RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4403
Practice Address - Country:US
Practice Address - Phone:619-738-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No284300000XHospitalsSpecial Hospital
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0091733OtherWOLLCARE COMMUNITY HEALTH NETWORK