Leroy Otto Egenberger, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MFC21358 Issued in CA

Practice address

1101 Standiford Ave
Suite B-2
Modesto, CA 95350-0982

Phone

(209) 522-5035

Fax

(209) 522-5134

NPI assigned

Dec 5, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290038400000",
    "number": "1922082726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 STANDIFORD AVE",
            "address_2": "SUITE B-2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953500982",
            "telephone_number": "209-522-5035",
            "fax_number": "209-522-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 STANDIFORD AVE",
            "address_2": "SUITE B-2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953500982",
            "telephone_number": "209-522-5035",
            "fax_number": "209-522-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGENBERGER",
        "first_name": "LEROY",
        "middle_name": "OTTO",
        "name_prefix": "Mr.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2010-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "MFC21358",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC21358",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STANISLAUS COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES",
            "identifier": "1922082726",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Modesto, CA
• Providers in Modesto, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.