Active NPI
Diane Wesson Jackson, MFC
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1417257312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC13334
- Practice address
- 1531 Purdue Ave
Suite Number 103
Los Angeles, CA 90025-3104 - Phone
- (310) 478-6263
- Fax
- (310) 456-8456
- NPI assigned
- Oct 25, 2010
- 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 | MFC13334 | CA | Primary |
Addresses
Primary practice location
1531 Purdue Ave
Suite Number 103
Los Angeles, CA 90025-3104
Mailing address
1531 Purdue Ave
Suite Number 103
Los Angeles, CA 90025-3104
Phone (310) 478-6263
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FEID 95-4177659 | Other | CA | FEDERAL ID FOR TAXES |
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 |
|---|---|---|---|
| MFC13334 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287964800000",
"number": "1417257312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1531 PURDUE AVE",
"address_2": "SUITE NUMBER 103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900253104",
"telephone_number": "310-478-6263",
"fax_number": "310-456-8456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1531 PURDUE AVE",
"address_2": "SUITE NUMBER 103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900253104",
"telephone_number": "310-478-6263",
"fax_number": "310-456-8456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIANE",
"middle_name": "WESSON",
"name_prefix": "Dr.",
"credential": "MFC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-25",
"last_updated": "2010-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC13334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL ID FOR TAXES",
"identifier": "FEID 95-4177659",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.