Active NPI
Constance Shin, LMFT
- Marriage & Family Therapist
- Lakewood, CA
National Provider Identifier
1750827291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 48639
- Practice address
- 4010 Watson Plaza Dr
Suite 285
Lakewood, CA 90712-4037 - Phone
- (562) 497-1505
- Fax
- (562) 497-1881
- NPI assigned
- Jan 9, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 48639 | CA | Primary |
Addresses
Primary practice location
4010 Watson Plaza Dr
Suite 285
Lakewood, CA 90712-4037
Mailing address
4010 Watson Plaza Dr
Suite 285
Lakewood, CA 90712-4037
Phone (562) 497-1505
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 25, 2025 through Aug 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48639 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483920000000",
"number": "1750827291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 WATSON PLAZA DR",
"address_2": "SUITE 285",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907124037",
"telephone_number": "562-497-1505",
"fax_number": "562-497-1881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 WATSON PLAZA DR",
"address_2": "SUITE 285",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907124037",
"telephone_number": "562-497-1505",
"fax_number": "562-497-1881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "CONSTANCE",
"name_prefix": "Miss",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-09",
"last_updated": "2017-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "48639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.