Active NPI
Christine Keiko Ota-Clemons, MS MFTI
- Mental Health Counselor
- Carson, CA
National Provider Identifier
1427170042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMF66490
- Practice address
- 460 E Carson Plaza Dr
Carson, CA 90746-3228 - Phone
- (310) 523-9500
- Fax
- (310) 255-2725
- NPI assigned
- Apr 4, 2007
- Last updated
- Jun 25, 2013
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMF66490 | CA | Primary |
Addresses
Primary practice location
460 E Carson Plaza Dr
Carson, CA 90746-3228
Mailing address
4724 W 12TH St
Los Angeles, CA 90019-3003
Phone (213) 663-9870
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00007570 | Medicaid | CA | |
| SUBB890 | Other | CA | LA DMH PROVIDER |
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 |
|---|---|---|---|
| IMF66490 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1427170042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4724 W 12TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900193003",
"telephone_number": "213-663-9870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 E CARSON PLAZA DR",
"city": "CARSON",
"state": "CA",
"postal_code": "907463228",
"telephone_number": "310-523-9500",
"fax_number": "310-255-2725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTA-CLEMONS",
"first_name": "CHRISTINE",
"middle_name": "KEIKO",
"name_prefix": "Mrs.",
"credential": "MS MFTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-04",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "IMF66490",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00007570",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA DMH PROVIDER",
"identifier": "SUBB890",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.