Simon Nfosak Mbongo, LVN

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

VN211623 Issued in CA

Practice address

2001 The Alameda
San Jose, CA 95126-1136

Phone

(408) 261-7777

NPI assigned

Feb 20, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Simon Nfosak Mbongo Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1659796191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1583 MARIETTA DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951182136",
            "telephone_number": "408-800-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261136",
            "telephone_number": "408-261-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBONGO",
        "first_name": "SIMON",
        "middle_name": "NFOSAK",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-20",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "VN211623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIMON",
            "last_name": "MBONGO",
            "middle_name": "NFOSAK",
            "credential": "LVN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Michelle Denise MC Donald, MA LMFT
• Amanda Rose MC Kannon

• Mental Health Counselor in San Jose, CA
• Providers in San Jose, 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 Feb 20, 2014; 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.