Individual provider Active NPI

Jamie D. Russell

  • Mental Health Counselor
  • Gardena, CA
National Provider Identifier
1043450158
Registry record updated Mar 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
130 W Victoria St
Gardena, CA 90248-3523
Phone
(310) 715-2020
NPI assigned
Mar 2, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

130 W Victoria St
Gardena, CA 90248-3523

Mailing address

702 Main St
Unit a
Huntington Beach, CA 92648-3402
Phone (714) 536-7294

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235952000000",
    "number": "1043450158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 MAIN ST",
            "address_2": "UNIT A",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926483402",
            "telephone_number": "714-536-7294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W VICTORIA ST",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902483523",
            "telephone_number": "310-715-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JAMIE",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-02",
        "last_updated": "2009-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.