IFEANYI JIMMY
NPI 1679189724
Marriage & Family Therapist in Manteca, CA

Q: What is Ifeanyi Jimmy's NPI number?

The NPI number for Ifeanyi Jimmy is 1679189724. It was assigned to this individual provider in the NPPES registry on September 23, 2020.

Q: What is Ifeanyi Jimmy's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: When was this NPI record last updated?

The NPPES record for Ifeanyi Jimmy was last updated on June 16, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 23, 2020PECOS Enrolled

302 CHERRY LN, MANTECA, CA 95337(530) 893-0758 Get Directions Write a Review

NPPES record last updated: June 16, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 16, 2023, Sep 23, 2020 (2 updates tracked since 2020).

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About Ifeanyi Jimmy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IFEANYI JIMMY (NPI 1679189724) is an individual marriage & family therapist in Manteca, California, licensed in California (132326) and active in the NPI registry since September 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1679189724

Entity TypeIndividualMale

Primary Taxonomy106H00000X

Provider Legal NameIFEANYI JIMMY

Location Address302 CHERRY LNManteca, CA 95337-4311

Mailing Address302 Cherry LnManteca, CA 95337-4311 · (530) 893-0758

Phone(530) 893-0758

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateSeptember 23, 2020

Last NPPES UpdateJune 16, 20232 updates tracked since enumeration

NPPES CertifiedJune 16, 2023

✔ NPI 1679189724 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 132326

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

302 CHERRY LN, Manteca, CA 95337

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ifeanyi Jimmy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3779067236

PECOS Enrollment IDI20260323002322

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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