Active NPI
Angelique Bagley, MFT
- Marriage & Family Therapist
- Campbell, CA
National Provider Identifier
1073643235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC37081
- Practice address
- 30 Union Ave
Suite 122
Campbell, CA 95008-3162 - Phone
- (408) 380-3005
- NPI assigned
- Mar 6, 2007
- Last updated
- Apr 7, 2014
- 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 | MFC37081 | CA | Primary |
Addresses
Primary practice location
30 Union Ave
Suite 122
Campbell, CA 95008-3162
Mailing address
30 Union Ave
Suite 122
Campbell, CA 95008-3162
Phone (408) 380-3005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 5, 2024 through Mar 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC37081 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Janet Johnston-Tyler | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396828800000",
"number": "1073643235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 UNION AVE",
"address_2": "SUITE 122",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950083162",
"telephone_number": "408-380-3005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 UNION AVE",
"address_2": "SUITE 122",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950083162",
"telephone_number": "408-380-3005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGLEY",
"first_name": "ANGELIQUE",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2014-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC37081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.