Active NPI
Michelle Marie Hackett, LMFT
- Marriage & Family Therapist
- Fairfield, CA
National Provider Identifier
1821645383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 111565
- Practice address
- 1745 Enterprise Dr.
BLDG. 2, Ste 1a
Fairfield, CA 94533 - Phone
- (707) 927-4282
- Fax
- (707) 247-4233
- NPI assigned
- Aug 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 111565 | CA | Primary |
Addresses
Primary practice location
1745 Enterprise Dr.
BLDG. 2, Ste 1a
Fairfield, CA 94533
Mailing address
5055 Business Center Dr.
Ste. 108 # 193
Fairfield, CA 94534
Phone (707) 366-0120
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644537600000",
"number": "1821645383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5055 BUSINESS CENTER DR.",
"address_2": "STE. 108 # 193",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "94534",
"telephone_number": "707-366-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 ENTERPRISE DR.",
"address_2": "BLDG. 2, STE 1A",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "94533",
"telephone_number": "707-927-4282",
"fax_number": "707-247-4233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKETT",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-20",
"last_updated": "2022-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "111565",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "The Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "1301 Roman Wy",
"city": "Martinez",
"state": "CA",
"country_code": "US",
"postal_code": "94553",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.