Individual provider Active NPI

Kim Leigh Anne Czemeres

  • Marriage & Family Therapist
  • Brea, CA
National Provider Identifier
1437416633
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC 45130 Issued in CA
Practice address
3 Pointe Dr
Suite #305
Brea, CA 92821-7622
Phone
(714) 318-1848
Fax
(714) 256-9013
NPI assigned
Apr 12, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MHC 00233 RI
Marriage & Family Therapist 106H00000X MFC 45130 CA Primary

Addresses

Primary practice location

3 Pointe Dr
Suite #305
Brea, CA 92821-7622

Mailing address

24475 Avenida de Marcia
Yorba Linda, CA 92887-4023
Phone (714) 694-1979

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

LicenseStateTypeSpecialty
MHC 00233RIMDMental Health Counselor
MFC 45130CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1437416633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24475 AVENIDA DE MARCIA",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928874023",
            "telephone_number": "714-694-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 POINTE DR",
            "address_2": "SUITE #305",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928217622",
            "telephone_number": "714-318-1848",
            "fax_number": "714-256-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZEMERES",
        "first_name": "KIM",
        "middle_name": "LEIGH ANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-12",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "MHC 00233",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 45130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.