Cadisha Alexa Gravesande, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

117966 Issued in CA

Practice address

10532 Acacia St Ste B4
Rancho Cucamonga, CA 91730-5455

Phone

(909) 325-3766

Fax

(626) 737-6034

NPI assigned

Mar 19, 2020

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1255967410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD STE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-701-4249",
            "fax_number": "626-737-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10532 ACACIA ST STE B4",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305455",
            "telephone_number": "909-325-3766",
            "fax_number": "626-737-6034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 E Foothill Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Arcadia",
            "state": "CA",
            "postal_code": "910062361",
            "country_code": "US",
            "telephone_number": "626-701-4249",
            "fax_number": "626-737-6034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVESANDE",
        "first_name": "CADISHA",
        "middle_name": "ALEXA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "117966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BBS",
            "identifier": "117966",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.Soultenders.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "address_1": "41 E Foothill Blvd Ste 102",
            "city": "Arcadia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "910062361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Marriage & Family Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.