Bethany Minick, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

121987 Issued in CA

Practice address

940 56TH St
San Diego, CA 92114-1714

Phone

(619) 871-6412

NPI assigned

Oct 13, 2020

Sex

Female

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

Specialty

Marriage and Family Therapist

Education

National Medical University, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blue Moon Senior Counseling of California LLCGroup PAC ID 9335360981, 79 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Moon Senior Counseling of California LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1447678990

  CA

  Medicare reassignment Care Compare group NPD
• Karma Doctors & Associates, P.C.

  • Psychiatry Physician
  • Villa Park, CA
  • NPI 1205450418
  Medicare reassignment
• Karma TMS PC

  • Psychiatry Physician
  • Palm Springs, CA
  • NPI 1508504689
  NPD (past)
• Freeport Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  NPD (past)

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1114525995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 56TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921141714",
            "telephone_number": "619-871-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 56TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921141714",
            "telephone_number": "619-871-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINICK",
        "first_name": "BETHANY",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "121987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John David Mingo, PSYD
• Christopher Stephen Mingrone, M.D.
• Minh B Pham Dental Corporation
• Minh B. Pham D.D.S. Inc.
• Minh Pham and Diana DO Dental Corporation
• Elizabeth Ann Minicucci, CNMW
• Matthew Minihan
• Alicia Grace Minirth
• Joel Minjares
• April Marie Minjarez, PHD, LMFT

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, 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 13, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.