FULLERTON COUNSELING AND MEDICAL GROUP, INC (NPI# 1821131673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821131673 |
| Entity Type | Organization |
| Organization Name | FULLERTON COUNSELING AND MEDICAL GROUP, INC |
| Practice Address |
2228 N State College Blvd Fullerton CA 92831-1361 |
| Practice Telephone | 7149900700 |
| Practice Fax Number | 7149900142 |
| Mailing Telephone | 7149900700 |
| Mailing Fax Number | 7149900142 |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2015-03-26 |
| Authorized Official Name | JUSTINE ANNE PETRIE (PRESIDENT) |
| Authorized Official Telephone | 7149900700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
PSY6172 | CA | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
PSY15282 | CA | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | ML012201 | CA | Behavioral Health & Social Service Providers |
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
C38832 | CA | Behavioral Health & Social Service Providers |
| Street Address |
2228 N STATE COLLEGE BLVD |
| City | FULLERTON |
| State | CA |
| Zip Code | 92831-1361 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861584922 | Kimberly Marie Hagan | Psychologist | 2228 N State College Blvd, Fullerton Counseling & Medical Group Inc, Fullerton, CA 92831 | 2006-09-28 |
| 1649795873 | Doctors Choice Sleep Testing Inc | Family Medicine | 2228 N State College Blvd, Fullerton, CA 92831-1361 | 2017-08-09 |
| 1932322484 | John C Gardner | Marriage & Family Therapist | 2228 N State College Blvd, Fullerton, CA 92831-1361 | 2007-04-11 |
| 1730264912 | Justine Anne Petrie | Psychiatry & Neurology | 2228 N State College Blvd, Fullerton, CA 92831-1361 | 2006-10-26 |
| 1124113550 | Richard A Fry | Psychologist | 2228 N State College Blvd, Fullerton, CA 92831-1361 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982169280 | Jennifer Ann Carroll | Counselor | 2246 N. State College Blvd, Fullerton, CA 92831 | 2019-01-31 |
| 1043733736 | Jimmy K Bhatt | Dentist | 1126 E Commonweath Ave, Fullerton, CA 92831 | 2017-07-25 |
| 1447625090 | Kairos Management | Assisted Living Facility | 1621 E. Chapman Ave, Fullerton, CA 92831 | 2015-12-08 |
| 1407251630 | Sam's West, Inc | Technician/Technologist | 601 S Placentia Ave, Fullerton, CA 92831 | 2014-10-30 |
| 1114361813 | Teresa Kyu Thin Khoo | Internal Medicine | 1907 Deerpark Dr Apt 546, Fullerton, CA 92831 | 2013-04-24 |
| 1699020586 | Julia A Bock | Occupational Therapy Assistant | 1240 N Frances Avenue, Fullerton, CA 92831 | 2012-07-17 |
| 1649566225 | The Center for The Treatment of Addiction | Preferred Provider Organization | 104 N. Raymond Ave., A-2, Fullerton, CA 92831 | 2011-06-22 |
| 1366746877 | Leticia Vallejo | Rehabilitation Practitioner | 801 E.chapman Ave, Fullerton, CA 92831 | 2010-12-28 |
| 1083916860 | Angelica Victoria Norman | Counselor | 801 East Chapman Suite 203, Fullerton, CA 92831 | 2010-11-30 |
| 1457683237 | The Paradise | Home Delivered Meals | 659 S Sate College Blvd., Ste. 51, Fullerton, CA 92831 | 2010-02-04 |
| Find all providers in zip 92831 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770985004 | M2 Creative | Psychologist | 6715 Melrose Ave, Los Angeles, CA 90038-3411 | 2014-09-18 |
| 1508294083 | Silverlining Psychiatry Medical Group | Psychologist | 3252 Holiday Ct Ste 108, La Jolla, CA 92037-1807 | 2013-10-21 |
| 1235408089 | Behavioral Research Specialists, LLC | Psychologist | 230 N. Maryland Ave, #309, Glendale, CA 91206 | 2011-12-23 |
| 1730342957 | United Behavioral Center, Inc | Psychologist | 834 W Avenue J, Lancaster, CA 93534-3427 | 2008-07-08 |
| 1528245917 | Claude E. Arnett | Psychologist | 403 N Susan St, Santa Ana, CA 92703-3433 | 2008-01-28 |
| 1811102908 | Mary Ann Barr | Psychologist | 277 Cascade Dr, Mill Valley, CA 94941-5025 | 2007-05-11 |
| 1255544557 | Pituck Medical Group, Inc. | Psychologist | 5858 Magnolia Ave Ste C, Riverside, CA 92506-1886 | 2007-05-07 |
| 1932320389 | Ricque L. Brister | Psychologist | 56 Hanover Ln, Suite., 100, Chico, CA 95973-7230 | 2007-05-02 |
| 1013539121 | Sally Kei Mason | Psychologist | 510 Plaza Dr Ste 170, Folsom, CA 95630-4790 | 2020-05-12 |
| 1043691025 | New Day Institute | Psychologist | 6391 Magnolia Ave, Suite A, Riverside, CA 92506-2424 | 2015-06-15 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FULLERTON COUNSELING AND MEDICAL GROUP, INC.
| 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.