Individual provider Active NPI

Mitch Nodelman

  • Marriage & Family Therapist
  • Van Nuys, CA
National Provider Identifier
1083491732
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
142547 Issued in CA
Practice address
5805 Sepulveda Blvd Ste 710
Van Nuys, CA 91411-2522
Phone
(213) 637-5000
NPI assigned
Sep 14, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X
Marriage & Family Therapist 106H00000X 142547 CA Primary

Addresses

Primary practice location

5805 Sepulveda Blvd Ste 710
Van Nuys, CA 91411-2522

Mailing address

5805 Sepulveda Blvd Ste 710
Van Nuys, CA 91411-2522
Phone (213) 637-5000

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

NPI Registry JSON

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

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1083491732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 SEPULVEDA BLVD STE 710",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112522",
            "telephone_number": "213-637-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 SEPULVEDA BLVD STE 710",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112522",
            "telephone_number": "213-637-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NODELMAN",
        "first_name": "MITCH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-14",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "142547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.