Active NPI
Jack Nelson Soll, M.F.T.
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1023369691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC24662
- Practice address
- 12011 San Vicente Blvd.,
Suite 305
Los Angeles, CA 90049 - Phone
- (310) 471-2210
- NPI assigned
- Sep 24, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC24662 | CA | Primary |
Addresses
Primary practice location
12011 San Vicente Blvd.,
Suite 305
Los Angeles, CA 90049
Mailing address
12011 San Vicente Blvd.,
Suite 305
Los Angeles, CA 90049
Phone (310) 471-2210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC24662 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1023369691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12011 SAN VICENTE BLVD.,",
"address_2": "SUITE 305",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-471-2210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12011 SAN VICENTE BLVD.,",
"address_2": "SUITE 305",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-471-2210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOLL",
"first_name": "JACK",
"middle_name": "NELSON",
"name_prefix": "Mr.",
"credential": "M.F.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-24",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC24662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.