Active NPI
Eboni Threatt
- Marriage & Family Therapist
- Fullerton, CA
National Provider Identifier
1295114734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- IMF69809
- Practice address
- 2601 E Chapman Ave
Ste. 116
Fullerton, CA 92831-3737 - Phone
- (714) 526-6643
- Fax
- (949) 502-4725
- NPI assigned
- May 28, 2015
- 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 | IMF69809 | CA | Primary |
Addresses
Primary practice location
2601 E Chapman Ave
Ste. 116
Fullerton, CA 92831-3737
Mailing address
4199 Campus Dr
Suite 300
Irvine, CA 92612-4684
Phone (949) 502-4721
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 |
|---|---|---|---|
| IMF69809 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432771200000",
"number": "1295114734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4199 CAMPUS DR",
"address_2": "SUITE 300",
"city": "IRVINE",
"state": "CA",
"postal_code": "926124684",
"telephone_number": "949-502-4721",
"fax_number": "949-502-4725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 E CHAPMAN AVE",
"address_2": "STE. 116",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928313737",
"telephone_number": "714-526-6643",
"fax_number": "949-502-4725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THREATT",
"first_name": "EBONI",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-28",
"last_updated": "2015-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF69809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.