Charles Matthew Mortensen

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

91935 Issued in CA

Practice address

9452 Texhoma Avenue
Northridge, CA 91325

Phone

(818) 521-0320

NPI assigned

May 23, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463702400000",
    "number": "1801189998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9452 TEXHOMA AVE",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913252333",
            "telephone_number": "818-521-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9452 TEXHOMA AVENUE",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91325",
            "telephone_number": "818-521-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "CHARLES",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-23",
        "last_updated": "2016-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "91935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Northridge, CA
• Providers in Northridge, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.