Individual provider Active NPI

Bethany Holder, M.S., LMFT

  • Marriage & Family Therapist
  • San Clemente, CA
National Provider Identifier
1689097925
Registry record updated Oct 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
52156 Issued in CA
Practice address
616 S El Camino Real
Suite G-9
San Clemente, CA 92672-4298
Phone
(949) 427-1104
NPI assigned
Jan 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2014

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 52156 CA Primary

Addresses

Primary practice location

616 S El Camino Real
Suite G-9
San Clemente, CA 92672-4298

Mailing address

55 Half Moon TRL
Ladera Ranch, CA 92694-0215
Phone (949) 842-7884

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Previously, effective Sep 1, 2024 through Sep 1, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Holder Foundation Marriage & Family Therapist Current Accepting new patients
Beth Holder Licensed Marriage and Family Therapy Inc Marriage & Family Therapist CurrentSince Jul 25, 2021 Accepting new patients

Locations

302 N El Camino Real
Ste 202
San Clemente, CA 92672
Phone (619) 356-0774

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": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414195200000",
    "number": "1689097925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 HALF MOON TRL",
            "city": "LADERA RANCH",
            "state": "CA",
            "postal_code": "926940215",
            "telephone_number": "949-842-7884",
            "fax_number": "949-364-6334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S EL CAMINO REAL",
            "address_2": "SUITE G-9",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724298",
            "telephone_number": "949-427-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "BETHANY",
        "credential": "M.S., LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "52156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.