Active NPI
Ethan John Messer, MA
- Mental Health Counselor
- La Mesa, CA
National Provider Identifier
1124150057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 128272
- Practice address
- 5480 Baltimore Dr Ste 202
La Mesa, CA 91942-2015 - Phone
- (619) 277-7843
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 128272 | CA | Primary |
Addresses
Primary practice location
5480 Baltimore Dr Ste 202
La Mesa, CA 91942-2015
Mailing address
5480 Baltimore Dr Ste 202
La Mesa, CA 91942-2015
Phone (619) 277-7843
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 25, 2024 through Jan 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128272 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688342400000",
"number": "1124150057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5480 BALTIMORE DR STE 202",
"city": "LA MESA",
"state": "CA",
"postal_code": "919422015",
"telephone_number": "619-277-7843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5480 BALTIMORE DR STE 202",
"city": "LA MESA",
"state": "CA",
"postal_code": "919422015",
"telephone_number": "619-277-7843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESSER",
"first_name": "ETHAN",
"middle_name": "JOHN",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-09",
"last_updated": "2023-07-03",
"certification_date": "2023-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "128272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.