Active NPI
John Brent Lague, PSYD
- Clinical Psychologist
- Glendale, CA
National Provider Identifier
1124673447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY24031
- Practice address
- 1101 N Pacific Ave Ste 204
Glendale, CA 91202-4316 - Phone
- (626) 806-8652
- NPI assigned
- Aug 4, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY24031 | CA | Primary |
Addresses
Primary practice location
1101 N Pacific Ave Ste 204
Glendale, CA 91202-4316
Mailing address
202 N Madison Ave
Monrovia, CA 91016-1553
Phone (626) 806-8652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24031 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564876800000",
"number": "1124673447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 N MADISON AVE",
"city": "MONROVIA",
"state": "CA",
"postal_code": "910161553",
"telephone_number": "626-806-8652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 N PACIFIC AVE STE 204",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912024316",
"telephone_number": "626-806-8652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAGUE",
"first_name": "JOHN",
"middle_name": "BRENT",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-04",
"last_updated": "2019-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY24031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.