NPIMap

Organization Active NPI

Epiphany Counseling, Consulting & Treatment Services, PC

  • Clinical Social Worker
  • San Pedro, CA
National Provider Identifier
1376922328
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW64555 Issued in CA
Legal business name
EPIPHANY COUNSELING, CONSULTING & TREATMENT SERVICES, PC
Practice address
302 W 5TH St Ste 308
San Pedro, CA 90731-2750
Phone
(424) 376-8705
Fax
(424) 363-1721
NPI assigned
May 22, 2015
Last updated
Oct 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Authorized official

Name
Miyume McKinley, LCSWNPI 1285812875
Title
Owner
Phone
(424) 570-6955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X LCSW64555 CA Primary

Addresses

Primary practice location

302 W 5TH St Ste 308
San Pedro, CA 90731-2750

Mailing address

302 W 5TH St Ste 308
San Pedro, CA 90731-2750
Phone (424) 570-6955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161004002053 CA Part B Supplier - Clinic/Group Practice 2062700214 Receives reassigned benefits from 1 practitioner
Practice locations: San Pedro, CA

National Provider Directory

National Provider Directory

Locations

302 W 5th St
Ste 308
San Pedro, CA 90731
Phone (424) 570-6955

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1376922328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W 5TH ST STE 308",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312750",
            "telephone_number": "424-570-6955",
            "fax_number": "424-363-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W 5TH ST STE 308",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312750",
            "telephone_number": "424-376-8705",
            "fax_number": "424-363-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY COUNSELING, CONSULTING & TREATMENT SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "MCKINLEY",
        "authorized_official_first_name": "MIYUME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "424-570-6955",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW64555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.