Active NPI
Jennifer Deforest, MFT INTERN
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1053780064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 70261
- Practice address
- 7461 Beverly Blvd
Unit 405
Los Angeles, CA 90036-2704 - Phone
- (323) 939-6355
- NPI assigned
- Sep 20, 2015
- 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 | 70261 | CA | Primary |
Addresses
Primary practice location
7461 Beverly Blvd
Unit 405
Los Angeles, CA 90036-2704
Mailing address
PO Box 4492
Chatsworth, CA 91313-4492
Phone (818) 282-3554
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 |
|---|---|---|---|
| 70261 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Miracle Mile Community Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Los Angeles, CA
- NPI 1386024115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442707200000",
"number": "1053780064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4492",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913134492",
"telephone_number": "818-282-3554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7461 BEVERLY BLVD",
"address_2": "UNIT 405",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900362704",
"telephone_number": "323-939-6355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFOREST",
"first_name": "JENNIFER",
"credential": "MFT INTERN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-20",
"last_updated": "2015-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "70261",
"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 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.