Active NPI
Mary Ann Thomas
- Addiction (Substance Use Disorder) Counselor
- Long Beach, CA
National Provider Identifier
1679057590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 71767
- Practice address
- 1775 Chestnut Ave
Long Beach, CA 90813-1674 - Phone
- (562) 412-2077
- Fax
- (888) 792-6665
- NPI assigned
- Sep 17, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | CA | ||
| Health Information Specialist/Technologist | 246Y00000X | CA | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 71767 | CA | Primary |
Addresses
Primary practice location
1775 Chestnut Ave
Long Beach, CA 90813-1674
Mailing address
6163 Atlantic Ave Ste 132
Long Beach, CA 90805-2922
Phone (562) 412-2077
Other practice location 1
6666 Green Valley Cir
Culver City, CA 90230-7068
Phone (213) 718-0256
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150072238 | Other | CA | ADULT EDUCATION INSTRUCTOR |
| 71767 | Other | CA | CALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONAL |
| 170063421 | Other | CA | CHILD DEVELOPMENT PROGRAM DIRECTOR PERMIT |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1679057590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6163 ATLANTIC AVE STE 132",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908052922",
"telephone_number": "562-412-2077",
"fax_number": "888-792-6665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 CHESTNUT AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908131674",
"telephone_number": "562-412-2077",
"fax_number": "888-792-6665"
}
],
"practiceLocations": [
{
"address_1": "6666 Green Valley Cir",
"address_purpose": "LOCATION",
"city": "Culver City",
"state": "CA",
"postal_code": "902307068",
"country_code": "US",
"telephone_number": "213-718-0256",
"fax_number": "888-792-6665",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THOMAS",
"first_name": "MARY",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-17",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "246Y00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Health Information",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "71767",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADULT EDUCATION INSTRUCTOR",
"identifier": "150072238",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONAL",
"identifier": "71767",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILD DEVELOPMENT PROGRAM DIRECTOR PERMIT",
"identifier": "170063421",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.