Individual provider Active NPI

Jessica Lazos, LMFT

  • Marriage & Family Therapist
  • La Quinta, CA
National Provider Identifier
1548748494
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
129101 Issued in CA
Practice address
78401 Highway 111 Ste U
La Quinta, CA 92253-2066
Phone
(760) 289-5295
Fax
(442) 300-2118
NPI assigned
Aug 2, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 107155 CA
Marriage & Family Therapist 106H00000X 129101 CA Primary

Addresses

Primary practice location

78401 Highway 111 Ste U
La Quinta, CA 92253-2066

Mailing address

68680 Dinah Shore Dr Apt 20B
Cathedral City, CA 92234-5721
Phone (760) 574-8414

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
107155CAMDMental Health Counselor
129101CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Marriage and Family Counseling Inc Marriage & Family Therapist PastSince Oct 20, 2019 Accepting new patients
Desert Marriage Family Counseling Inc PastSince Oct 20, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1548748494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68680 DINAH SHORE DR APT 20B",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922345721",
            "telephone_number": "760-574-8414",
            "fax_number": "442-300-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78401 HIGHWAY 111 STE U",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922532066",
            "telephone_number": "760-289-5295",
            "fax_number": "442-300-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZOS",
        "first_name": "JESSICA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-02",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "107155",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "129101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Quinta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.