Mary Pat Leonie Paulson, APCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11226 Issued in CA

Practice address

925 Broadbeck Dr
Newbury Park, CA 91320-1269

Phone

(805) 242-3120

NPI assigned

Nov 23, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1669161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1255040770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 YUCCA DR",
            "city": "SANTA ROSA VALLEY",
            "state": "CA",
            "postal_code": "930129377",
            "telephone_number": "818-519-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BROADBECK DR",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913201269",
            "telephone_number": "805-242-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "MARY PAT",
        "middle_name": "LEONIE",
        "credential": "APCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-23",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "11226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "other",
            "affiliation": "N",
            "endpointDescription": "other",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "other",
            "address_1": "925 Broadbeck Dr",
            "city": "Newbury Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913201269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Newbury Park, CA
• Providers in Newbury Park, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.

Verify at the official NPI Registry.