Active NPI
Elva Mouton, MFTI
- Marriage & Family Therapist
- Dublin, CA
National Provider Identifier
1205154135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 56478
- Practice address
- 5325 Broder Blvd
Dublin, CA 94568-3309 - Phone
- (925) 551-6740
- Fax
- (925) 551-6727
- NPI assigned
- May 17, 2010
- Sex
- Female
- 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 | 56478 | CA | Primary |
Addresses
Primary practice location
5325 Broder Blvd
Dublin, CA 94568-3309
Mailing address
1 E Lake CT
Antioch, CA 94509-2040
Phone (925) 753-5025
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000 | Other | NONE |
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 |
|---|---|---|---|
| 56478 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274054400000",
"number": "1205154135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 E LAKE CT",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945092040",
"telephone_number": "925-753-5025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5325 BRODER BLVD",
"city": "DUBLIN",
"state": "CA",
"postal_code": "945683309",
"telephone_number": "925-551-6740",
"fax_number": "925-551-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUTON",
"first_name": "ELVA",
"name_prefix": "Ms.",
"credential": "MFTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-17",
"last_updated": "2010-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "56478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Dublin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.