Active NPI
Vivian Blas, MFT 17709MFT
- Marriage & Family Therapist
- Burbank, CA
National Provider Identifier
1467522243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 17709MFT
- Practice address
- 4405 Riverside Dr
Suite 106
Burbank, CA 91504 - Phone
- (818) 845-0366
- Fax
- (818) 972-9033
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 17709MFT | CA | Primary |
Addresses
Primary practice location
4405 Riverside Dr
Suite 106
Burbank, CA 91504
Mailing address
4405 Riverside Dr
Suite 106
Burbank, CA 91504
Phone (818) 845-0366
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17709 | Other | CA | MFT |
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 |
|---|---|---|---|
| 17709MFT | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467522243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4405 RIVERSIDE DR",
"address_2": "SUITE 106",
"city": "BURBANK",
"state": "CA",
"postal_code": "91504",
"telephone_number": "818-845-0366",
"fax_number": "818-972-9033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 RIVERSIDE DR",
"address_2": "SUITE 106",
"city": "BURBANK",
"state": "CA",
"postal_code": "91504",
"telephone_number": "818-845-0366",
"fax_number": "818-972-9033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAS",
"first_name": "VIVIAN",
"name_prefix": "Mrs.",
"credential": "MFT 17709MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "17709MFT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT",
"identifier": "17709",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.