Nicole Lynn Goolsby, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

98829 Issued in CA

Practice address

219 N Indian Hill Blvd Ste 102
Claremont, CA 91711-4644

Phone

(909) 206-4453

NPI assigned

Feb 10, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 12, 2024 through Jan 12, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Nicole Goolsby, Licensed Marriage and Family Therapist, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Claremont, CA
  • NPI 1760941199
  NPD Authorized official

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

{
    "created_epoch": "1265760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1124350475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9266",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917018266",
            "telephone_number": "909-206-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 N INDIAN HILL BLVD STE 102",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114644",
            "telephone_number": "909-206-4453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "790 E Bonita Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917671906",
            "country_code": "US",
            "telephone_number": "909-935-5228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10601 Civic Center Dr Ste 120B",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303878",
            "country_code": "US",
            "telephone_number": "909-206-4453",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10601 Civic Center Dr Ste 120B",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303878",
            "country_code": "US",
            "telephone_number": "909-206-4453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOOLSBY",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-10",
        "last_updated": "2022-07-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "98829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Claremont, CA
• Providers in Claremont, 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 21, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.