Active NPI
D'Andra Nelson
- Marriage & Family Therapist
- Lynwood, CA
National Provider Identifier
1750752358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT148090
- Practice address
- 2594 Industry Way
Lynwood, CA 90262-4015 - Phone
- (310) 631-8004
- NPI assigned
- Oct 8, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | IMF96244 | CA | |
| Marriage & Family Therapist | 106H00000X | 136170 | CA | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Marriage & Family Therapist | 106H00000X | LMFT148090 | CA | Primary |
Addresses
Primary practice location
2594 Industry Way
Lynwood, CA 90262-4015
Mailing address
2594 Industry Way
Lynwood, CA 90262-4015
Phone (310) 631-8004
Other practice location 1
10221 Compton Ave
Los Angeles, CA 90002-2802
Phone (213) 385-5100
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136170 | CA | MD | Clinical Social Worker |
| IMF96244 | CA | MD | Marriage & Family Therapist |
| LMFT148090 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forward Wellness Family Therapy, Inc. | Current | Accepting new patients | |
| Southern California Health & Rehabilitation Program | Past | Accepting new patients | |
| Southern California Health & Rehabilitation Program | Past | Accepting new patients | |
| Southern California Health & Rehabilitation Program | Past | Accepting new patients |
Locations
1041 E Yorba Linda Blvd
Ste 202
Placentia, CA 92870
Phone (714) 579-0717
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/scharpca/r4/
Organizations & group practices 4
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.
-
- Community/Behavioral Health Agency
- Placentia, CA
- NPI 1093398059
-
- Community/Behavioral Health Agency
- Los Angeles, CA
- NPI 1083743082
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1467775221
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1689793739
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1750752358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2594 INDUSTRY WAY",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902624015",
"telephone_number": "310-631-8004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2594 INDUSTRY WAY",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902624015",
"telephone_number": "310-631-8004"
}
],
"practiceLocations": [
{
"address_1": "10221 Compton Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900022802",
"country_code": "US",
"telephone_number": "213-385-5100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NELSON",
"first_name": "D'ANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-08",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF96244",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "136170",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT148090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lynwood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.