Active NPI
Jeremy Dastic, LMFT
- Marriage & Family Therapist
- Arroyo Grande, CA
National Provider Identifier
1649752635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 96863
- Practice address
- 130 W Branch St Ste B
Arroyo Grande, CA 93420-6617 - Phone
- (805) 242-8164
- NPI assigned
- Sep 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 96863 | CA | Primary |
Addresses
Primary practice location
130 W Branch St Ste B
Arroyo Grande, CA 93420-6617
Mailing address
130 W Branch St Ste B
Arroyo Grande, CA 93420-6617
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 |
|---|---|---|---|
| 96863 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559779200000",
"number": "1649752635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 W BRANCH ST STE B",
"city": "ARROYO GRANDE",
"state": "CA",
"postal_code": "934206617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 W BRANCH ST STE B",
"city": "ARROYO GRANDE",
"state": "CA",
"postal_code": "934206617",
"telephone_number": "805-242-8164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASTIC",
"first_name": "JEREMY",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-05",
"last_updated": "2019-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "96863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arroyo Grande, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.