Active NPI
Jessica L Minckley, LMHC, ATR-BC
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1790401339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LH61457229
- Practice address
- 3370 Glendale Blvd # 733
Los Angeles, CA 90039-4836 - Phone
- (323) 612-0571
- Fax
- (206) 703-3372
- NPI assigned
- Oct 14, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Art Therapist | 221700000X | 22455 | ||
| Mental Health Counselor | 101YM0800X | 6161075 | ID | |
| Mental Health Counselor | 101YM0800X | LH61457229 | WA | Primary |
Addresses
Primary practice location
3370 Glendale Blvd # 733
Los Angeles, CA 90039-4836
Mailing address
3512 La Clede Ave Apt 102
Los Angeles, CA 90039-1950
Phone (503) 926-0081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 10, 2025 through Sep 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH61457229 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Art Therapy for All | Mental Health | Current | Accepting new patients |
Locations
3370 Glendale Blvd
#733
Los Angeles, CA 90039
Phone (323) 612-0571
Organizations & group practices 1
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": "1665705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1790401339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3512 LA CLEDE AVE APT 102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900391950",
"telephone_number": "503-926-0081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3370 GLENDALE BLVD # 733",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900394836",
"telephone_number": "323-612-0571",
"fax_number": "206-703-3372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINCKLEY",
"first_name": "JESSICA",
"middle_name": "L",
"credential": "LMHC, ATR-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-14",
"last_updated": "2026-07-13",
"certification_date": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "221700000X",
"taxonomy_group": "",
"desc": "Art Therapist",
"state": null,
"license": "22455",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "6161075",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH61457229",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.