Individual provider Active NPI

Brian Stachowiak, LMFT

  • Marriage & Family Therapist
  • Los Angeles, CA
National Provider Identifier
1669726709
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
126154 Issued in CA
Practice address
2820 Glendale Blvd Ste 6
Los Angeles, CA 90039-2723
Phone
(213) 770-0820
NPI assigned
Oct 26, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 126154 CA Primary

Addresses

Primary practice location

2820 Glendale Blvd Ste 6
Los Angeles, CA 90039-2723

Mailing address

2820 Glendale Blvd Ste 6
Los Angeles, CA 90039-2723
Phone (213) 770-0820

Other identifiers 1

IdentifierTypeStateIssuer
01261511MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Feb 7, 2024 through Feb 7, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
126154CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1669726709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 GLENDALE BLVD STE 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392723",
            "telephone_number": "213-770-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 GLENDALE BLVD STE 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392723",
            "telephone_number": "213-770-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACHOWIAK",
        "first_name": "BRIAN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-26",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "126154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01261511",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.