Active NPI
Jacquelyn Harlan
- Psychologist
- Fountain Valley, CA
National Provider Identifier
1134563133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 9550 Warner Ave Ste 250
Fountain Valley, CA 92708-2842 - Phone
- (714) 593-2300
- NPI assigned
- Apr 20, 2013
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
9550 Warner Ave Ste 250
Fountain Valley, CA 92708-2842
Mailing address
PO Box 25913
Santa Ana, CA 92799-5913
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 16, 2024 through Jul 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366416000000",
"number": "1134563133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 25913",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927995913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9550 WARNER AVE STE 250",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082842",
"telephone_number": "714-593-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARLAN",
"first_name": "JACQUELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-20",
"last_updated": "2013-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.