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KERRI N. BOUTELLE PHD NPI 1780620906


NPI Information

NPI: 1780620906
Provider Name: KERRI N. BOUTELLE, PHD
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
9500 GILMAN DRIVE MC 0985
UNIVERSITY OF CALIFORNIA SAN DIEGO
LA JOLLA, CA
ZIP 92093
Phone: (858) 534-8037
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Kerri N. Boutelle, PHD is a clinical psychologist in La Jolla, CA. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. Kerri N. Boutelle, PHD NPI is 1780620906. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

9500 GILMAN DRIVE MC 0985
UNIVERSITY OF CALIFORNIA SAN DIEGO
LA JOLLA, CA
ZIP 92093
Phone: (858) 534-8037
Fax: (858) 534-6727

The NPI 1780620906 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 6/22/2006 and was last updated on 7/22/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinicalPSY21823CALIFORNIAYes
2103TC2200XPsychologistClinical Child & AdolescentPSY21823CALIFORNIANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1205A4BOOTHERMINNESOTABCBS
20491997MEDICAIDMONTANA
339136900OTHERWISCONSINWI MA
47777470MEDICAIDSOUTH DAKOTA
510387OTHERNORTH DAKOTAND MA
6123420OTHERMINNESOTAUCARE
761-60634OTHERMINNESOTAMEDICA CHOICE & PRIMARY
8923517500MEDICAIDMINNESOTA
9HP34903OTHERMINNESOTAHEALTHPARTNERS
101019785OTHERMINNESOTAPREFERRED ONE
11839397OTHERMINNESOTAARAZ

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.