Active NPI
Brett Dahlberg
- Mental Health Counselor
- Santa Cruz, CA
National Provider Identifier
1477069755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1400 Emeline Ave
Santa Cruz, CA 95060-1976 - Phone
- (831) 454-4170
- NPI assigned
- Dec 21, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CA | Primary |
Addresses
Primary practice location
1400 Emeline Ave
Santa Cruz, CA 95060-1976
Mailing address
1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4170
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ92069Z | Other | CA | SANTA CRUZ COUNTY GROUP PTAN# |
| FHC70042F | Other | CA | SANTA CRUZ COUNTY MEDI-CAL GROUP PTAN# |
| ZZZ91891Z | Other | CA | SANTA CRUZ COUNTY MEDICARE GROUP PTAN# |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1477069755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601976",
"telephone_number": "831-454-4170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601976",
"telephone_number": "831-454-4170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLBERG",
"first_name": "BRETT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-21",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANTA CRUZ COUNTY GROUP PTAN#",
"identifier": "ZZZ92069Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANTA CRUZ COUNTY MEDI-CAL GROUP PTAN#",
"identifier": "FHC70042F",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANTA CRUZ COUNTY MEDICARE GROUP PTAN#",
"identifier": "ZZZ91891Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.