Active NPI
Kristina Jackson, MFT
- Marriage & Family Therapist
- Hermosa Beach, CA
National Provider Identifier
1023477114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC35584
- Practice address
- 2309 Pacific Coast Hwy
Suite 102
Hermosa Beach, CA 90254-2751 - Phone
- (310) 480-7324
- NPI assigned
- Feb 17, 2016
- Sex
- Female
- 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 | MFC35584 | CA | Primary |
Addresses
Primary practice location
2309 Pacific Coast Hwy
Suite 102
Hermosa Beach, CA 90254-2751
Mailing address
2309 Pacific Coast Hwy
Suite 102
Hermosa Beach, CA 90254-2751
Phone (310) 480-7324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 9, 2025 through Apr 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC35584 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1023477114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2309 PACIFIC COAST HWY",
"address_2": "SUITE 102",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542751",
"telephone_number": "310-480-7324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2309 PACIFIC COAST HWY",
"address_2": "SUITE 102",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542751",
"telephone_number": "310-480-7324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KRISTINA",
"name_prefix": "Ms.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-17",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC35584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermosa Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.