Active NPI
Suzanna Anderson
- Mental Health Counselor
- Perris, CA
National Provider Identifier
1124595780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5672
- Practice address
- 555 N Perris Blvd
Perris, CA 92571-2811 - Phone
- (951) 436-5300
- Fax
- (951) 436-5352
- NPI assigned
- Oct 31, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5672 | CA | Primary |
Addresses
Primary practice location
555 N Perris Blvd
Perris, CA 92571-2811
Mailing address
555 N Perris Blvd
Perris, CA 92571-2811
Phone (951) 436-5300
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5672 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540944000000",
"number": "1124595780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 N PERRIS BLVD",
"city": "PERRIS",
"state": "CA",
"postal_code": "925712811",
"telephone_number": "951-436-5300",
"fax_number": "951-436-5352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 N PERRIS BLVD",
"city": "PERRIS",
"state": "CA",
"postal_code": "925712811",
"telephone_number": "951-436-5300",
"fax_number": "951-436-5352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "SUZANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2018-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "5672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perris, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.