Lina Israelyan, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

116940 Issued in CA

Practice address

300 Pullman St BLDG B
Livermore, CA 94551-9756

Phone

(925) 294-7106

NPI assigned

Aug 28, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1093063703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PULLMAN ST BLDG B",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945519756",
            "telephone_number": "925-294-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PULLMAN ST BLDG B",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945519756",
            "telephone_number": "925-294-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISRAELYAN",
        "first_name": "LINA",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-28",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "116940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "300 Pullman St Bldg B",
            "city": "Livermore",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945519756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jackson River Holdings LLC (Stratford Villa Post-Acute)
• Cynthia Jackson
• Shawn Jackson
• Elicia Marie Jacobs, A.T.C.

• Marriage & Family Therapist in Livermore, CA
• Providers in Livermore, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.