Individual provider Active NPI

Breyon Clemmons

  • Marriage & Family Therapist
  • San Bernardino, CA
National Provider Identifier
1821581240
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
137097 Issued in CA
Practice address
290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone
(909) 963-5355
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 105719 CA
Marriage & Family Therapist 106H00000X 137097 CA Primary

Addresses

Primary practice location

290 N D St Ste 700
San Bernardino, CA 92401-1705

Mailing address

290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone (909) 963-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251001004253 CA Practitioner - Marriage and Family Therapist 6608372339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3281 E Guasti Rd
Suite 600
Ontario, CA 91761-1221

3281 E Guasti Rd
Suite 600
Ontario, CA 91761-7611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105719CAMDMarriage & Family Therapist
137097CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Step Up on Second Street Inc. CurrentSince Jan 12, 2025 Accepting new patients

Locations

290 N D St
Ste 700
San Bernardino, CA 92401
Phone (909) 963-5355

Organizations & group practices 2

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": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1821581240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMMONS",
        "first_name": "BREYON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "105719",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "137097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.