Active NPI
Samantha Mortinsen
- Marriage & Family Therapist
- Moreno Valley, CA
National Provider Identifier
1710333109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- IMF88445
- Practice address
- 12968 Frederick St Ste a
Moreno Valley, CA 92553-5229 - Phone
- (951) 505-3664
- NPI assigned
- May 4, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PCCI2116 | CA | |
| Marriage & Family Therapist | 106H00000X | IMF88445 | CA | Primary |
Addresses
Primary practice location
12968 Frederick St Ste a
Moreno Valley, CA 92553-5229
Mailing address
12968 Frederick St Ste a
Moreno Valley, CA 92553-5229
Phone (951) 505-3664
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 |
|---|---|---|---|
| PCCI2116 | CA | MD | Professional Counselor |
| IMF88445 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462320000000",
"number": "1710333109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12968 FREDERICK ST STE A",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925535229",
"telephone_number": "951-505-3664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12968 FREDERICK ST STE A",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925535229",
"telephone_number": "951-505-3664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTINSEN",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-04",
"last_updated": "2016-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "PCCI2116",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF88445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.