Active NPI
Carrissa Michelle Daino Jones
- Marriage & Family Therapist
- San Pedro, CA
National Provider Identifier
1629690334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 150762
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128934 | CA | MD | Mental Health Counselor |
| 150762 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forward Wellness Family Therapy, Inc. | Current | Accepting new patients | |
| Pacific Clinics | Past | Accepting new patients | |
| Pacific Clinics | Past | 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.
-
- Community/Behavioral Health Agency
- Placentia, CA
- NPI 1093398059
-
- Community/Behavioral Health Agency
- Fresno, CA
- NPI 1336458934
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1710132691
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.