Myrtle MC Intosh Kalugin

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMFT48824 Issued in CA

Practice address

13710 La Mirada Blvd
La Mirada, CA 90638-3028

Phone

(562) 943-0195

Fax

(562) 902-2962

NPI assigned

Aug 19, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Straight Talk Clinic, Inc

  • Community/Behavioral Health Agency
  • La Mirada, CA
  • NPI 1568672640
  NPD (past)

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1609423268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13710 LA MIRADA BLVD",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906383028",
            "telephone_number": "562-943-0195",
            "fax_number": "562-902-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13710 LA MIRADA BLVD",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906383028",
            "telephone_number": "562-943-0195",
            "fax_number": "562-902-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALUGIN",
        "first_name": "MYRTLE",
        "middle_name": "MC INTOSH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-19",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LMFT48824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON OUBLISHING COMPANY",
            "identifier": "106H00000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruth Antoinette Johnson, MS
• Joon Woo Sohn, DMD, PC
• JSRK Healthcare LLC
• Dong Min Jung, RDH
• JW Jacob Chae DMD Inc
• Ji Kang, L.AC.
• Angela Kay Kasprzak, AMFT
• Christopher G Katcherian, MD
• Sugra Shiraz Kathiriya, M.D.
• Neil T Katz, M.D.

• Mental Health Counselor in La Mirada, CA
• Providers in La Mirada, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.

Verify at the official NPI Registry.