Healthcare Provider Details

I. General information

NPI: 1578899159
Provider Name (Legal Business Name): JASON FERRELL M.S. - PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W MIDWAY DR
ANAHEIM CA
92805-6507
US

IV. Provider business mailing address

202 SAN TROPEZ CT
LAGUNA BEACH CA
92651-4414
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-7107
  • Fax:
Mailing address:
  • Phone: 949-412-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: