Mike Fatula, MS, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

M15257 Issued in CA

Practice address

519 N la Cienega Blvd
#16
West Hollywood, CA 90048-2007

Phone

(323) 422-9433

Fax

(323) 876-8941

NPI assigned

Aug 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114035235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7985 SANTA MONICA BLVD",
            "address_2": "#109 - 18",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900465074",
            "telephone_number": "323-422-9433",
            "fax_number": "323-876-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 N LA CIENEGA BLVD",
            "address_2": "#16",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900482007",
            "telephone_number": "323-422-9433",
            "fax_number": "323-876-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATULA",
        "first_name": "MIKE",
        "credential": "MS, MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "M15257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in West Hollywood, CA
• Providers in West Hollywood, 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 Jul 8, 2007; 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.