Healthcare Provider Details

I. General information

NPI: 1982918744
Provider Name (Legal Business Name): JAMES L IPPOLITO MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

IV. Provider business mailing address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number55060
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2541
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: