Active NPI
Matthew Nickle
- Marriage & Family Therapist
- San Pedro, CA
National Provider Identifier
1942656426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 92602
- Practice address
- 1891 N Gaffey St
230
San Pedro, CA 90731-1267 - Phone
- (310) 831-1967
- NPI assigned
- May 13, 2016
- Last updated
- May 13, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 92602 | CA | Primary |
Addresses
Primary practice location
1891 N Gaffey St
230
San Pedro, CA 90731-1267
Mailing address
PO Box 7000-15
Redondo Beach, CA 90277
Phone (424) 225-1638
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 |
|---|---|---|---|
| 92602 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463097600000",
"number": "1942656426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7000-15",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "90277",
"telephone_number": "424-225-1638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1891 N GAFFEY ST",
"address_2": "230",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907311267",
"telephone_number": "310-831-1967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLE",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-13",
"last_updated": "2016-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "92602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.