Individual provider Active NPI

Judith Ann Tegland, LMFT

  • Marriage & Family Therapist
  • Sonoma, CA
National Provider Identifier
1669976312
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT31669 Issued in CA
Practice address
203 Temelec Cir
Sonoma, CA 95476-8027
Phone
(415) 430-7470
NPI assigned
Mar 19, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 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 LMFT31669 CA Primary

Addresses

Primary practice location

203 Temelec Cir
Sonoma, CA 95476-8027

Mailing address

203 Temelec Cir
Sonoma, CA 95476-8027
Phone (415) 430-7470

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240524001332 CA Practitioner - Marriage and Family Therapist 8729420526 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT31669CAMDMarriage & Family Therapist
31669CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Mental Health CurrentSince Apr 13, 2024 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1669976312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 TEMELEC CIR",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954768027",
            "telephone_number": "415-430-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 TEMELEC CIR",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954768027",
            "telephone_number": "415-430-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEGLAND",
        "first_name": "JUDITH",
        "middle_name": "ANN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-19",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT31669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonoma, CA

Sources for this page

Verify at the official NPI Registry.