Active NPI
Justin Paul Phillips
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1598092462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 114115
- Practice address
- 1835 Allston Way
Berkeley, CA 94703-1764 - Phone
- (510) 666-9552
- NPI assigned
- Nov 12, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Marriage & Family Therapist | 106H00000X | 114115 | CA | Primary |
Addresses
Primary practice location
1835 Allston Way
Berkeley, CA 94703-1764
Mailing address
30086 Mission Blvd
Hayward, CA 94544-7233
Phone (925) 989-5775
Other practice location 1
390 40th Street
Oakland, CA 94609
Phone (510) 318-6137
Other practice location 2
30086 Mission Blvd
Hayward, CA 94544-7233
Phone (925) 989-5775
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Terra Firma Diversion/Educational Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Hayward, CA
- NPI 1619345352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568073600000",
"number": "1598092462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30086 MISSION BLVD",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945447233",
"telephone_number": "925-989-5775",
"fax_number": "510-675-9468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1835 ALLSTON WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947031764",
"telephone_number": "510-666-9552"
}
],
"practiceLocations": [
{
"address_1": "390 40th Street",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "94609",
"country_code": "US",
"telephone_number": "510-318-6137",
"fax_number": "510-675-9468",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "30086 Mission Blvd",
"address_purpose": "LOCATION",
"city": "Hayward",
"state": "CA",
"postal_code": "945447233",
"country_code": "US",
"telephone_number": "925-989-5775",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JUSTIN",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-12",
"last_updated": "2019-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "114115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.