Tara Diane Pentecost, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

138280 Issued in CA

Practice address

1478 E Lincoln Ave
Anaheim, CA 92805-2213

Phone

(714) 776-2500

NPI assigned

Oct 2, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blue Moon Senior Counseling of California LLCGroup PAC ID 9335360981, 79 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Blue Moon Senior Counseling of California LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1447678990

  CA

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1720868474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 E NOHL RANCH RD APT 96",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928074893",
            "telephone_number": "714-606-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 E LINCOLN AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928052213",
            "telephone_number": "714-776-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTECOST",
        "first_name": "TARA",
        "middle_name": "DIANE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-02",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "138280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shuchin Jessica Peng, M.A., OTR/L
• Vivienne Weiju Peng, PMHNP-BC
• William Swen-Yu Peng
• Kimberly Dianne Penilla
• Kenshennda Dollie Penn
• Celena Marie Perales
• Fabiola Peralta Rodriguez
• Chris Peralta
• Rachel Peralta, M.S., L.C.G.C.
• Elizabeth Perdomo

• Marriage & Family Therapist in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.