Active NPI
Judi Lynn Bagley, LMFT
- Marriage & Family Therapist
- Tustin, CA
National Provider Identifier
1376563866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT13101
- Practice address
- 17542 Irvine Blvd Ste F
Tustin, CA 92780-3155 - Phone
- (714) 508-1919
- Fax
- (714) 508-1935
- NPI assigned
- Jul 20, 2006
- 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 | MFT13101 | CA | Primary |
Addresses
Primary practice location
17542 Irvine Blvd Ste F
Tustin, CA 92780-3155
Mailing address
90 Montana del Lago Dr
Rancho Santa Margarita, CA 92688-1366
Phone (949) 510-3861
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 |
|---|---|---|---|
| MFT13101 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376563866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 MONTANA DEL LAGO DR",
"city": "RANCHO SANTA MARGARITA",
"state": "CA",
"postal_code": "926881366",
"telephone_number": "949-510-3861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17542 IRVINE BLVD STE F",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803155",
"telephone_number": "714-508-1919",
"fax_number": "714-508-1935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGLEY",
"first_name": "JUDI",
"middle_name": "LYNN",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFT13101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tustin, 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.