Active NPI
Joseph Licon
- Marriage & Family Therapist
- Victorville, CA
National Provider Identifier
1831963685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 137300
- Practice address
- 13261 Spring Valley Parkway
Ste 205
Victorville, CA 92395 - Phone
- (442) 243-2714
- NPI assigned
- Nov 13, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 137300 | CA | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
13261 Spring Valley Parkway
Ste 205
Victorville, CA 92395
Mailing address
PO Box 9402
Redlands, CA 92375-2602
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137300 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699833600000",
"number": "1831963685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9402",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923752602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13261 SPRING VALLEY PARKWAY",
"address_2": "STE 205",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "92395",
"telephone_number": "442-243-2714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICON",
"first_name": "JOSEPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-13",
"last_updated": "2023-11-13",
"certification_date": "2023-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "137300",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.