Theresa Michael Samuel Boko

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

251 Llewellyn Ave
Campbell, CA 95008-1940

Phone

(408) 379-3790

NPI assigned

Jul 10, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 17, 2025 through Aug 17, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1625875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1881266856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 MURGUIA AVE",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950506957",
            "telephone_number": "408-712-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 LLEWELLYN AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950081940",
            "telephone_number": "408-379-3790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3880 S Bascom Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951242675",
            "country_code": "US",
            "telephone_number": "408-355-9578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUEL BOKO",
        "first_name": "THERESA",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-10",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Campbell, CA
• Providers in Campbell, 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 Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.