Active NPI
Marissa Raquel Whorton
- Mental Health Counselor
- Menlo Park, CA
National Provider Identifier
1063164309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 103907
- 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
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 |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 103907 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Soul Centric Empowerment Center | Current | 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.
-
- Marriage & Family Therapist
- Menlo Park, CA
- NPI 1700522208
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.