Gino Anthony Memoli III

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT-962 Issued in HI

Practice address

11549 Los Osos Valley Rd Ste 103
San Luis Obispo, CA 93405-6457

Phone

(805) 235-7792

NPI assigned

Feb 28, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fortitude Marriage and Family Therapy Incorporated

  • Marriage & Family Therapist
  • San Luis Obispo, CA
  • NPI 1730947441
  NPD Authorized official
• Coastal Integrative Wellness, a Marriage and Family Corp

  • Marriage & Family Therapist
  • San Luis Obispo, CA
  • NPI 1477232932
  NPD (past)

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1285333252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11549 LOS OSOS VALLEY RD STE 103",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934056457",
            "telephone_number": "805-235-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11549 LOS OSOS VALLEY RD STE 103",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934056457",
            "telephone_number": "805-235-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMOLI",
        "first_name": "GINO",
        "middle_name": "ANTHONY",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-28",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TN",
            "license": "2552",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "14072848-3902",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "146784",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT-962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mick Scott Meiselman, MD
• Megan Lynne Meisenheimer, PT, DPT, OTR/L, CHT
• Jose Mejia
• Lindsey A Melendrez, APCC
• Cody W Mello
• Bailey Mena, PA-C
• Roberto Mena
• Manuel Menchaca
• Walter Mendez-Santeno
• Brenda Reyna Mendez, 9489 - R

• Marriage & Family Therapist in San Luis Obispo, CA
• Providers in San Luis Obispo, 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 Feb 26, 2026; 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.