TERRELL JASON FORTUNE (NPI# 1720349731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720349731 |
| Entity Type | Individual |
| Full Name | TERRELL JASON FORTUNE |
| Practice Address |
720 S. B St. San Mateo CA 94401 |
| Practice Telephone | 6505797157 |
| Practice Fax Number | 6505795530 |
| Mailing Telephone | 6505797157 |
| Mailing Fax Number | 6505795530 |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
720 S. B ST. |
| City | SAN MATEO |
| State | CA |
| Zip Code | 94401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800760 | Monica Marie Rivas | Behavior Technician | 429 Peninsula Avenue, San Mateo, CA 94401 | 2020-08-05 |
| 1609412865 | Cindy Toshiko Hedlin | Marriage & Family Therapist | 1117 S. B Street, Suite 9, San Mateo, CA 94401 | 2019-11-22 |
| 1750846655 | James Court Manor Inc. | Assisted Living Facility | 1316 James Court, San Mateo, CA 94401 | 2019-02-05 |
| 1467991778 | Maria Elena Lopez | Student in an Organized Health Care Education/Training Program | 325 Villa Terrace, San Mateo, CA 94401 | 2017-02-20 |
| 1487198339 | Johnie Pangelina | Behavioral Analyst | 242 Peninsula Ave, San Mateo, CA 94401 | 2016-12-12 |
| 1740736230 | Meredith Eileen Morgan | Dentist | 100 S. Ellsworth Av, #601, San Mateo, CA 94401 | 2016-08-25 |
| 1376998963 | Lior Tamir | Dentist | 800 B Street Suite #200, San Mateo, CA 94401 | 2016-05-02 |
| 1609233584 | Delicia Ortega | Behavioral Analyst | 424 Peninsula Avenue, San Mateo, CA 94401 | 2016-01-22 |
| 1396122388 | Ramy Salah | Internal Medicine | 50 S San Mateo Dr Ste 480, San Mateo, CA 94401 | 2015-04-29 |
| 1508255902 | Risso Counseling, Inc. | Marriage & Family Therapist | 120 North El Camino Real, San Mateo, CA 94401 | 2015-01-22 |
| Find all providers in zip 94401 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245898196 | Jennifer Ranae Werner | Counselor | 3124 La Selva Cir Apt 8, San Mateo, CA 94403-2141 | 2019-06-04 |
| 1841751922 | Courtney Rose Cordova | Counselor | 29 N Humboldt St, San Mateo, CA 94401-2923 | 2019-03-29 |
| 1154897742 | Daniel George Vanisi | Counselor | 1752 Cottage Grove Ave, San Mateo, CA 94401-3114 | 2018-10-22 |
| 1114324944 | Sylvan P Selig IIi | Counselor | 1213 S Claremont St, San Mateo, CA 94402 | 2014-11-21 |
| 1447683115 | Roxanne J. Vogt | Counselor | 15 9th Avenue, San Mateo, CA 94401 | 2013-08-16 |
| 1750642195 | Randy G Suttles | Counselor | 720 Ss St, San Mateo, CA 94401-4245 | 2012-06-01 |
| 1457612996 | Robert Walter Szopa | Counselor | 720 S. B St, San Mateo, CA 94401 | 2012-05-31 |
| 1245598861 | Justin Lacson | Counselor | 2251 Palm Avenue, San Mateo, CA 94401 | 2012-05-02 |
| 1518255694 | Kenneth Allen Robinson | Counselor | 720 So. B Street, San Mateo, CA 94401 | 2011-07-11 |
| 1922395219 | David Ross Clemens | Counselor | 720 South B St., San Mateo, CA 94401 | 2011-07-07 |
| Find all providers in SAN MATEO | ||||
Please comment or provide details below to improve the information on TERRELL JASON FORTUNE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.