Active NPI
Desiree Michelle Gottfried, LMFT
- Marriage & Family Therapist
- Banning, CA
National Provider Identifier
1053663930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 114843
- Practice address
- 1627 S Hargrave St
Banning, CA 92220-6169 - Phone
- (951) 922-7612
- NPI assigned
- Oct 3, 2012
- 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 | 114843 | CA | Primary |
Addresses
Primary practice location
1627 S Hargrave St
Banning, CA 92220-6169
Mailing address
1627 S Hargrave St
Banning, CA 92220-6169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114843 | Other | CA | BOARD OF BEHAVIORAL SCIENCES |
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 |
|---|---|---|---|
| 114843 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618185600000",
"number": "1053663930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1627 S HARGRAVE ST",
"city": "BANNING",
"state": "CA",
"postal_code": "922206169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1627 S HARGRAVE ST",
"city": "BANNING",
"state": "CA",
"postal_code": "922206169",
"telephone_number": "951-922-7612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTFRIED",
"first_name": "DESIREE",
"middle_name": "MICHELLE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-03",
"last_updated": "2021-04-12",
"certification_date": "2021-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "114843",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIORAL SCIENCES",
"identifier": "114843",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.