Individual provider Active NPI

Michelle Sara Glicksman, MFT

  • Marriage & Family Therapist
  • Sacramento, CA
National Provider Identifier
1922215169
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
5445 Laurel Hills Dr
Sacramento, CA 95841-3105
Phone
(916) 710-5890
Fax
(916) 609-5160
NPI assigned
May 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

5445 Laurel Hills Dr
Sacramento, CA 95841-3105

Mailing address

5445 Laurel Hills Dr
Sacramento, CA 95841-3105
Phone (916) 710-5890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240607002332 CA Practitioner - Marriage and Family Therapist 3577005362 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Center for New Directions, Inc. CurrentSince Apr 21, 2024 Accepting new patients
Stephen M Pumphrey Licensed Clinical Social Workers Inc PastSince Dec 25, 2018 Accepting new patients

Locations

23201 Mill Creek Dr
Ste 220
Laguna Hills, CA 92653
Phone (949) 460-5320

1100 Melody Ln
Ste 108
Roseville, CA 95678

27201 Tourney Rd
Ste 206
Valencia, CA 91355

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1922215169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 LAUREL HILLS DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958413105",
            "telephone_number": "916-710-5890",
            "fax_number": "916-609-5160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 LAUREL HILLS DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958413105",
            "telephone_number": "916-710-5890",
            "fax_number": "916-609-5160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICKSMAN",
        "first_name": "MICHELLE",
        "middle_name": "SARA",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.