Active NPI
Jeremy Tait Dailey, LMFT, PHD
- Marriage & Family Therapist
- San Juan Capistrano, CA
National Provider Identifier
1891442919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 130723
- Practice address
- 31726 Rancho Viejo Rd Ste 100
San Juan Capistrano, CA 92675-2723 - Phone
- (949) 670-8855
- NPI assigned
- Mar 8, 2022
- Last updated
- Apr 22, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 130723 | CA | Primary |
Addresses
Primary practice location
31726 Rancho Viejo Rd Ste 100
San Juan Capistrano, CA 92675-2723
Mailing address
31726 Rancho Viejo Rd Ste 100
San Juan Capistrano, CA 92675-2723
Phone (949) 670-8855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 130723 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713744000000",
"number": "1891442919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31726 RANCHO VIEJO RD STE 100",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926752723",
"telephone_number": "949-670-8855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31726 RANCHO VIEJO RD STE 100",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926752723",
"telephone_number": "949-670-8855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAILEY",
"first_name": "JEREMY",
"middle_name": "TAIT",
"credential": "LMFT, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-08",
"last_updated": "2024-04-22",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "130723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan Capistrano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.