Active NPI
Adam J Boardman, MA, LMFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1700579869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 139730
- Practice address
- 11661 San Vicente Blvd Ste 606
Los Angeles, CA 90049-5114 - Phone
- (424) 279-4779
- NPI assigned
- Jun 2, 2023
- 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 | 139730 | CA | Primary |
Addresses
Primary practice location
11661 San Vicente Blvd Ste 606
Los Angeles, CA 90049-5114
Mailing address
1223 Wilshire Blvd
BMB 422
Santa Monica, CA 90403-5406
Phone (424) 279-4779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Aug 15, 2025 through Aug 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 139730 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1700579869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1223 WILSHIRE BLVD",
"address_2": "BMB 422",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904035406",
"telephone_number": "424-279-4779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11661 SAN VICENTE BLVD STE 606",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495114",
"telephone_number": "424-279-4779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOARDMAN",
"first_name": "ADAM",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MA, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-02",
"last_updated": "2023-06-02",
"certification_date": "2023-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "139730",
"primary": true
}
],
"identifiers": [],
"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 Jun 2, 2023; 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.