Active NPI
Licia Wise, LMFT
- Marriage & Family Therapist
- Torrance, CA
National Provider Identifier
1679005581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 90769
- Practice address
- 21151 S Western Ave Ste 255
Torrance, CA 90501-1724 - Phone
- (310) 919-6815
- NPI assigned
- Mar 30, 2017
- Sex
- Female
- 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 | 90769 | CA | Primary |
Addresses
Primary practice location
21151 S Western Ave Ste 255
Torrance, CA 90501-1724
Mailing address
1302 E 3Rd St
Apt. 24
Long Beach, CA 90802-3677
Phone (310) 919-6815
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 |
|---|---|---|---|
| 90769 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542758400000",
"number": "1679005581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 E 3RD ST",
"address_2": "APT. 24",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908023677",
"telephone_number": "310-919-6815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21151 S WESTERN AVE STE 255",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905011724",
"telephone_number": "310-919-6815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "LICIA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-30",
"last_updated": "2018-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "90769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.