Active NPI
Jonathan Vickburg, LMFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1912348491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC50480
- Practice address
- 554 S San Vicente Blvd
Suite 110
Los Angeles, CA 90048-4647 - Phone
- (424) 832-6565
- Fax
- (424) 241-3120
- NPI assigned
- Jul 11, 2013
- 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 | MFC50480 | CA | Primary |
Addresses
Primary practice location
554 S San Vicente Blvd
Suite 110
Los Angeles, CA 90048-4647
Mailing address
554 S San Vicente Blvd
Suite 110
Los Angeles, CA 90048-4647
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 |
|---|---|---|---|
| MFC50480 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392076800000",
"number": "1912348491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 S SAN VICENTE BLVD",
"address_2": "SUITE 110",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 S SAN VICENTE BLVD",
"address_2": "SUITE 110",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484647",
"telephone_number": "424-832-6565",
"fax_number": "424-241-3120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKBURG",
"first_name": "JONATHAN",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-11",
"last_updated": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC50480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.