Individual provider Active NPI

Kerianne Christine Stephan

  • Marriage & Family Therapist
  • San Francisco, CA
National Provider Identifier
1679229918
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT150992 Issued in CA
Practice address
110 Gough St Ste 203
San Francisco, CA 94102-5945
Phone
(949) 351-6783
NPI assigned
Feb 24, 2022
Reactivated
Nov 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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 LMFT150992 CA Primary

Addresses

Primary practice location

110 Gough St Ste 203
San Francisco, CA 94102-5945

Mailing address

5700 N Winthrop Ave Apt 6
Chicago, IL 60660-4355
Phone (949) 351-6783

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

LicenseStateTypeSpecialty
LMFT150992CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stephan Marriage and Family Therapy Inc. Marriage & Family Therapist CurrentSince Mar 11, 2025 Accepting new patients
Mind-Body Care, Inc. PastSince May 3, 2015 Accepting new patients

Locations

110 Gough St
Ste 203
San Francisco, CA 94102
Phone (415) 236-3819

Organizations & group practices 2

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": "1645660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1679229918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 N WINTHROP AVE APT 6",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604355",
            "telephone_number": "949-351-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 GOUGH ST STE 203",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025945",
            "telephone_number": "949-351-6783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "KERIANNE",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-24",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "deactivation_date": "2022-04-12",
        "reactivation_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT150992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.