Active NPI
Angie Jo Nicholas, LMFT
- Marriage & Family Therapist
- Stockton, CA
National Provider Identifier
1679713796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 52080
- Practice address
- 4545 Georgetown PL
B-13
Stockton, CA 95207-6215 - Phone
- (209) 224-4994
- NPI assigned
- Mar 2, 2009
- Sex
- Female
- Sole proprietor
- No
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 | 52080 | CA | Primary |
Addresses
Primary practice location
4545 Georgetown PL
B-13
Stockton, CA 95207-6215
Mailing address
4908 Cozad Way
Stockton, CA 95212-1904
Phone (209) 244-4994
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 |
|---|---|---|---|
| 52080 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446422400000",
"number": "1679713796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4908 COZAD WAY",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952121904",
"telephone_number": "209-244-4994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4545 GEORGETOWN PL",
"address_2": "B-13",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952076215",
"telephone_number": "209-224-4994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "ANGIE",
"middle_name": "JO",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-02",
"last_updated": "2015-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "52080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.