Active NPI
Ian Kizanis
- Marriage & Family Therapist
- San Luis Obispo, CA
National Provider Identifier
1649008798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 148130
- Practice address
- 1411 Marsh St Ste 108
San Luis Obispo, CA 93401-2967 - Phone
- (805) 602-6845
- NPI assigned
- Jul 22, 2024
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 16723 | CA | |
| Marriage & Family Therapist | 106H00000X | 148130 | CA | Primary |
Addresses
Primary practice location
1411 Marsh St Ste 108
San Luis Obispo, CA 93401-2967
Mailing address
4479 Spanish Oaks Dr
San Luis Obispo, CA 93401-7805
Phone (805) 550-2423
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
| License | State | Type | Specialty |
|---|---|---|---|
| 148130 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1649008798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4479 SPANISH OAKS DR",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934017805",
"telephone_number": "805-550-2423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 MARSH ST STE 108",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934012967",
"telephone_number": "805-602-6845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIZANIS",
"first_name": "IAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-22",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "16723",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "148130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.