Active NPI
Brittiany Jefferson
- Marriage & Family Therapist
- Melissa, TX
National Provider Identifier
1083164628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 698
- Practice address
- 1203 Freestone Dr
Melissa, TX 75454-0730 - Phone
- (214) 785-1647
- NPI assigned
- Oct 6, 2016
- Last updated
- Oct 29, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | NU | ||
| Marriage & Family Therapist | 106H00000X | 698 | HI | Primary |
Addresses
Primary practice location
1203 Freestone Dr
Melissa, TX 75454-0730
Mailing address
4400 State Hwy 121
Ste 300 PMB 1249
Lewisville, TX 75056
Phone (254) 291-9573
Other practice location 1
615 Piikoi St Ste 203
Honolulu, HI 96814-3139
Phone (808) 589-1829 ext. 114
Other practice location 2
640 Ulukahiki St
Kailua, HI 96734-4454
Phone (808) 772-2873
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 |
|---|---|---|---|
| 698 | HI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hale Kipa, Inc. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Ewa Beach, HI
- NPI 1164627246
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1083164628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4400 STATE HWY 121",
"address_2": "STE 300 PMB 1249",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "75056",
"telephone_number": "254-291-9573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 FREESTONE DR",
"city": "MELISSA",
"state": "TX",
"postal_code": "754540730",
"telephone_number": "214-785-1647"
}
],
"practiceLocations": [
{
"address_1": "615 Piikoi St Ste 203",
"address_purpose": "LOCATION",
"city": "Honolulu",
"state": "HI",
"postal_code": "968143139",
"country_code": "US",
"telephone_number": "808-589-1829 x114",
"fax_number": "808-589-2610",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "640 Ulukahiki St",
"address_purpose": "LOCATION",
"city": "Kailua",
"state": "HI",
"postal_code": "967344454",
"country_code": "US",
"telephone_number": "808-772-2873",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JEFFERSON",
"first_name": "BRITTIANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-06",
"last_updated": "2024-10-29",
"certification_date": "2024-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "HI",
"license": "698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melissa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.