Active NPI
Bruce Charles Nickles, MFT
- Marriage & Family Therapist
- San Jose, CA
National Provider Identifier
1174014252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 39460
- Practice address
- 151 W Mission St
San Jose, CA 95110-1713 - Phone
- (408) 535-4255
- NPI assigned
- May 23, 2018
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 39460 | CA | Primary |
Addresses
Primary practice location
151 W Mission St
San Jose, CA 95110-1713
Mailing address
PO Box 110681
Campbell, CA 95011-0681
Phone (408) 593-1688
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 |
|---|---|---|---|
| 39460 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527033600000",
"number": "1174014252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 110681",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950110681",
"telephone_number": "408-593-1688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 W MISSION ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951101713",
"telephone_number": "408-535-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLES",
"first_name": "BRUCE",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-23",
"last_updated": "2018-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "39460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
- Nicholas Delpino Nicholas Delpino
- Jennifer Marie Nicholas, CADC II
- Aniyah Nachelle Nichols
- Felicita Magdalena Nichols
- Helen L Nichols, LMFT
- Nicole Bennett Therapy, a Licensed Clinical Social Worker Corp.
- Nicole Hong Phuong T. Thai , M.D., Inc
- Jennifer Lee Nicolet, MSW, MED, LCSW
- Nimisha Nidgundi, D.D.S
- Wenying Nie, L.AC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.