Active NPI
Mary Kathleen Passehl, MFT, PSY.D
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1053628388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35693
- Practice address
- 11965 Venice Blvd
Suite 405
Los Angeles, CA 90066-3979 - Phone
- (310) 566-7625
- NPI assigned
- Sep 8, 2010
- 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 | 35693 | CA | Primary |
Addresses
Primary practice location
11965 Venice Blvd
Suite 405
Los Angeles, CA 90066-3979
Mailing address
24637 Gardenstone LN
West Hills, CA 91307-3815
Phone (805) 427-3718
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 |
|---|---|---|---|
| 35693 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283904000000",
"number": "1053628388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24637 GARDENSTONE LN",
"city": "WEST HILLS",
"state": "CA",
"postal_code": "913073815",
"telephone_number": "805-427-3718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11965 VENICE BLVD",
"address_2": "SUITE 405",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663979",
"telephone_number": "310-566-7625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSEHL",
"first_name": "MARY",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "MFT, PSY.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-08",
"last_updated": "2010-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "35693",
"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 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.