Individual provider Active NPI

D'Andra Nelson

  • Marriage & Family Therapist
  • Lynwood, CA
National Provider Identifier
1750752358
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT148090 Issued in CA
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

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240906002169 CA Practitioner - Marriage and Family Therapist 9234679192 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
136170CAMDClinical Social Worker
IMF96244CAMDMarriage & Family Therapist
LMFT148090CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Forward Wellness Family Therapy, Inc. CurrentSince Aug 22, 2024 Accepting new patients
Southern California Health & Rehabilitation Program PastSince May 29, 2022 Accepting new patients
Southern California Health & Rehabilitation Program PastSince Nov 1, 2020 Accepting new patients
Southern California Health & Rehabilitation Program PastSince Nov 1, 2020 Accepting new patients

Locations

1041 E Yorba Linda Blvd
Ste 202
Placentia, CA 92870
Phone (714) 579-0717

Interoperability endpoints

  • FHIR API: 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.

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

Verify at the official NPI Registry.