Individual provider Active NPI

Carrissa Michelle Daino Jones

  • Marriage & Family Therapist
  • San Pedro, CA
National Provider Identifier
1629690334
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
150762 Issued in CA
Practice address
916 N Western Ave Ste 210
San Pedro, CA 90732-2407
Phone
(310) 957-2099
NPI assigned
May 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 128934 CA
Marriage & Family Therapist 106H00000X CA
Marriage & Family Therapist 106H00000X 150762 CA Primary

Addresses

Primary practice location

916 N Western Ave Ste 210
San Pedro, CA 90732-2407

Mailing address

1638 Huntington Dr Apt D
South Pasadena, CA 91030-4741
Phone (916) 690-2404

Other practice location 1

3680 E Imperial Hwy Ste 220
Lynwood, CA 90262-2663
Phone (323) 769-7174

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250217000849 CA Practitioner - Marriage and Family Therapist 8022548395 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
128934CAMDMental Health Counselor
150762CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Forward Wellness Family Therapy, Inc. CurrentSince Dec 4, 2024 Accepting new patients
Pacific Clinics PastSince Nov 1, 2021 Accepting new patients
Pacific Clinics PastSince Nov 1, 2021 Accepting new patients

Locations

1041 E Yorba Linda Blvd
Ste 202
Placentia, CA 92870
Phone (714) 579-0717

Organizations & group practices 3

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": "1589500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1629690334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1638 HUNTINGTON DR APT D",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304741",
            "telephone_number": "916-690-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 N WESTERN AVE STE 210",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322407",
            "telephone_number": "310-957-2099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3680 E Imperial Hwy Ste 220",
            "address_purpose": "LOCATION",
            "city": "Lynwood",
            "state": "CA",
            "postal_code": "902622663",
            "country_code": "US",
            "telephone_number": "323-769-7174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONES",
        "first_name": "CARRISSA",
        "middle_name": "MICHELLE DAINO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-15",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "128934",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "150762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

Verify at the official NPI Registry.