Nicole Marie Kloncz

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

118701 Issued in CA

Practice address

201 D St Ste G
Marysville, CA 95901-5957

Phone

(530) 237-1715

NPI assigned

Jan 28, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Revive Pathway

  • Substance Use Disorder Rehabilitation Clinic/Center
  • El Cajon, CA
  • NPI 1962117440

  TX

  Medicare reassignment NPD
• Puyallup Tribal Opioid Clinic, Inc.

  dba Cedar Wellness Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tacoma, WA
  • NPI 1992582613

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1386982239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 D ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959016017",
            "telephone_number": "530-671-3472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 D ST STE G",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959015957",
            "telephone_number": "530-237-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLONCZ",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-28",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "118701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Kiernan
• Destiny Kilpatrick
• Aditi Srinivasa Kini, M.S., CCC-SLP
• Deborah Jo Kirksey
• Peter Alan Kirkup
• Roberta Marie Klopf, PA-C
• Joanna Lee Knight, M.S.
• John Knoten Jr., RASI
• Davonna Marie Kornagay Fletcher
• Stephen Kotarek, PA

• Marriage & Family Therapist in Marysville, CA
• Providers in Marysville, 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 Jan 13, 2021; 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.