Jane Ellen Van Wagoner, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MR022526 Issued in CA

Practice address

1370 Brea Blvd Ste 120
Fullerton, CA 92835-4123

Phone

(714) 738-1733

Fax

(714) 996-1013

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972728657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 BREA BLVD STE 120",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354123",
            "telephone_number": "714-738-1733",
            "fax_number": "714-996-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 BREA BLVD STE 120",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354123",
            "telephone_number": "714-738-1733",
            "fax_number": "714-996-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGONER",
        "first_name": "JANE",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MR022526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.