Active NPI
Brace Bacon
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1801505367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 11710 San Vicente Blvd
Los Angeles, CA 90049-5006 - Phone
- (323) 405-7255
- NPI assigned
- Nov 23, 2022
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
11710 San Vicente Blvd
Los Angeles, CA 90049-5006
Mailing address
1011 Palm Ave Apt 301
West Hollywood, CA 90069-4092
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 12, 2024 through Mar 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669161600000",
"number": "1801505367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 PALM AVE APT 301",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900694092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11710 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495006",
"telephone_number": "323-405-7255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "BRACE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-23",
"last_updated": "2022-11-23",
"certification_date": "2022-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"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 Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.