Active NPI
Mark Clendenen Miller
- Marriage & Family Therapist
- San Jose, CA
National Provider Identifier
1033234927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC15474
- Practice address
- 90 Great Oaks Blvd
108
San Jose, CA 95119-1314 - Phone
- (408) 281-0708
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
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 | MFC15474 | CA | Primary |
Addresses
Primary practice location
90 Great Oaks Blvd
108
San Jose, CA 95119-1314
Mailing address
90 Great Oaks Blvd
San Jose, CA 95119-1314
Phone (408) 281-0708
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MFC15070 | Other | CA | MFT |
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 |
|---|---|---|---|
| MFC15474 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033234927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 GREAT OAKS BLVD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951191314",
"telephone_number": "408-281-0708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 GREAT OAKS BLVD",
"address_2": "108",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951191314",
"telephone_number": "408-281-0708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MARK",
"middle_name": "CLENDENEN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC15474",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT",
"identifier": "MFC15070",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.