Active NPI
Frederick Jon Chacon
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1144659459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- IMF77897
- Practice address
- 2523 W 7TH St
Los Angeles, CA 90057-3801 - Phone
- (626) 227-7014
- Fax
- (626) 227-7015
- NPI assigned
- Nov 6, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Marriage & Family Therapist | 106H00000X | IMF77897 | CA | Primary |
Addresses
Primary practice location
2523 W 7TH St
Los Angeles, CA 90057-3801
Mailing address
210 S de Lacey Ave
Suite 110
Pasadena, CA 91105-2048
Phone (626) 395-7100
Other practice location 1
210 S De Lacey Ave
suite 110
Pasadena, CA 91105-2048
Phone (626) 395-7100 ext. 2523
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19122731 | Other | CA | MEDICAL |
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 |
|---|---|---|---|
| IMF77897 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1144659459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S DE LACEY AVE",
"address_2": "SUITE 110",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052048",
"telephone_number": "626-395-7100",
"fax_number": "626-685-2126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2523 W 7TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900573801",
"telephone_number": "626-227-7014",
"fax_number": "626-227-7015"
}
],
"practiceLocations": [
{
"address_1": "210 S De Lacey Ave",
"address_2": "suite 110",
"address_purpose": "LOCATION",
"city": "Pasadena",
"state": "CA",
"postal_code": "911052048",
"country_code": "US",
"telephone_number": "626-395-7100 x2523",
"fax_number": "626-685-2126",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHACON",
"first_name": "FREDERICK",
"middle_name": "JON",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF77897",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "19122731",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.