Active NPI
Zachary Wyman
- Marriage & Family Therapist
- Redlands, CA
National Provider Identifier
1770976615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 94603
- Practice address
- 1362 E Lugonia Ave
Redlands, CA 92374-2713 - Phone
- (530) 614-0066
- NPI assigned
- Mar 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-16-22983 | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | 94603 | CA | Primary |
Addresses
Primary practice location
1362 E Lugonia Ave
Redlands, CA 92374-2713
Mailing address
1362 E Lugonia Ave
Redlands, CA 92374-2713
Phone (530) 614-0066
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-16-22983 | Other | BCBA CERTIFICATION | |
| 94603 | Other | ASSOCIATE MARRIAGE AND FAMILY THERAPY |
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 |
|---|---|---|---|
| 94603 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626912000000",
"number": "1770976615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1362 E LUGONIA AVE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923742713",
"telephone_number": "530-614-0066",
"fax_number": "909-252-4055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1362 E LUGONIA AVE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923742713",
"telephone_number": "530-614-0066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYMAN",
"first_name": "ZACHARY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-17",
"last_updated": "2021-07-22",
"certification_date": "2021-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-16-22983",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "94603",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBA CERTIFICATION",
"identifier": "1-16-22983",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASSOCIATE MARRIAGE AND FAMILY THERAPY",
"identifier": "94603",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.