Individual provider Active NPI

Amelia Owens Sullivan, MFT

  • Marriage & Family Therapist
  • Pacifica, CA
National Provider Identifier
1215902812
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
40618 Issued in CA
Practice address
1750 Francisco Blvd
Ste. 15
Pacifica, CA 94044-2582
Phone
(650) 355-1133
Fax
(650) 355-1133
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 40618 CA Primary

Addresses

Primary practice location

1750 Francisco Blvd
Ste. 15
Pacifica, CA 94044-2582

Mailing address

1750 Francisco Blvd
Suite #15
Pacifica, CA 94044-2582
Phone (650) 355-1133

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

LicenseStateTypeSpecialty
40618CAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215902812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 FRANCISCO BLVD",
            "address_2": "SUITE #15",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940442582",
            "telephone_number": "650-355-1133",
            "fax_number": "650-355-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 FRANCISCO BLVD",
            "address_2": "STE. 15",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940442582",
            "telephone_number": "650-355-1133",
            "fax_number": "650-355-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "AMELIA",
        "middle_name": "OWENS",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "40618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacifica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.