Active NPI
Patrick Jensen, MA, MFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1679826358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 81573
- Practice address
- 2402 Edgewater Ter
Los Angeles, CA 90039-3207 - Phone
- (323) 205-5027
- NPI assigned
- Oct 18, 2012
- Last updated
- Oct 21, 2014
- Sex
- Male
- 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 | 81573 | CA | Primary |
Addresses
Primary practice location
2402 Edgewater Ter
Los Angeles, CA 90039-3207
Mailing address
2402 Edgewater Ter
Los Angeles, CA 90039-3207
Phone (323) 205-5027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01261511 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1679826358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2402 EDGEWATER TER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900393207",
"telephone_number": "323-205-5027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2402 EDGEWATER TER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900393207",
"telephone_number": "323-205-5027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "PATRICK",
"credential": "MA, MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-18",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "81573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01261511",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.