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1821131673 NPI number — FULLERTON COUNSELING AND MEDICAL GROUP, INC

NPI Number: 1821131673
Health Care Provider/Practitioner: FULLERTON COUNSELING AND MEDICAL GROUP, INC

Information about “1821131673” NPI (FULLERTON COUNSELING AND MEDICAL GROUP, INC) exists in 1821131673 in HTML format HTML  |  1821131673 in plain Text format TXT  |  1821131673 in PDF (Portable Document Format) PDF  |  1821131673 in an XML format XML  formats.

NPI Number : 1821131673 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821131673",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FULLERTON COUNSELING AND MEDICAL GROUP, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2228 N STATE COLLEGE BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FULLERTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92831-1361",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-990-0700",
    "MailingAddressFaxNumber": "714-990-0142",
    "FirstLinePracticeLocationAddress": "2228 N STATE COLLEGE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FULLERTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92831-1361",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-990-0700",
    "PracticeLocationAddressFaxNumber": "714-990-0142",
    "EnumerationDate": "02/14/2007",
    "LastUpdateDate": "03/26/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PETRIE",
    "AuthorizedOfficialFirstName": "JUSTINE",
    "AuthorizedOfficialMiddleName": "ANNE",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "714-990-0700",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "PSY6172",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "PSY15282",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "ML012201",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TP0016X",
          "TaxonomyName": "Prescribing (Medical) Psychologist",
          "LicenseNumber": "C38832",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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