Active NPI
Jai Long, LMFT111561
- Marriage & Family Therapist
- Santa Monica, CA
National Provider Identifier
1154540714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT111561
- Practice address
- 3435 Ocean Park Blvd.
#207
Santa Monica, CA 90405 - Phone
- (310) 392-9474
- Fax
- (323) 294-7261
- NPI assigned
- Apr 24, 2007
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 75042 | CA | |
| Marriage & Family Therapist | 106H00000X | LMFT111561 | CA | Primary |
Addresses
Primary practice location
3435 Ocean Park Blvd.
#207
Santa Monica, CA 90405
Mailing address
1328 Second Street
Santa Monica, CA 90401
Phone (310) 576-1308
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 |
|---|---|---|---|
| LMFT111561 | CA | MD | Marriage & Family Therapist |
| 75042 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Step Up on Second Street Inc. | Past | Accepting new patients | |
| Step Up on Second Street, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- San Bernardino, CA
- NPI 1285186353
-
- Community/Behavioral Health Agency
- Santa Monica, CA
- NPI 1891825451
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554336000000",
"number": "1154540714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1328 SECOND STREET",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "90401",
"telephone_number": "310-576-1308",
"fax_number": "310-576-1027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3435 OCEAN PARK BLVD.",
"address_2": "#207",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "90405",
"telephone_number": "310-392-9474",
"fax_number": "323-294-7261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "JAI",
"name_prefix": "Mr.",
"credential": "LMFT111561",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2019-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "75042",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT111561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 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.