Individual provider Active NPI

Marissa Raquel Whorton

  • Mental Health Counselor
  • Menlo Park, CA
National Provider Identifier
1063164309
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
103907 Issued in CA
Practice address
3705 Haven Ave Ste 134
Menlo Park, CA 94025-1011
Phone
(650) 667-0117
NPI assigned
Jan 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 103907 CA Primary

Addresses

Primary practice location

3705 Haven Ave Ste 134
Menlo Park, CA 94025-1011

Mailing address

3705 Haven Ave Ste 134
Menlo Park, CA 94025-1011
Phone (650) 667-0117

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

LicenseStateTypeSpecialty
103907CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Soul Centric Empowerment Center CurrentSince May 16, 2022 Accepting new patients

Locations

3705 Haven Ave
Ste 134
Menlo Park, CA 94025
Phone (650) 667-0117

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1063164309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 HAVEN AVE STE 134",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940251011",
            "telephone_number": "650-667-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 HAVEN AVE STE 134",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940251011",
            "telephone_number": "650-667-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHORTON",
        "first_name": "MARISSA",
        "middle_name": "RAQUEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "103907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menlo Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.