Individual provider Active NPI

Chelsea Alexandria Staine

  • Clinical Social Worker
  • Lynwood, CA
National Provider Identifier
1215559901
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
129357 Issued in CA
Practice address
2620 Industry Way
Lynwood, CA 90262-4024
Phone
(310) 667-4070
NPI assigned
May 15, 2020
Last updated
Mar 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 109085 CA
Clinical Social Worker 1041C0700X 109085 CA
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X 129357 CA Primary

Addresses

Primary practice location

2620 Industry Way
Lynwood, CA 90262-4024

Mailing address

2620 Industry Way
Lynwood, CA 90262-4024
Phone (310) 667-4070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250716003848 CA Practitioner - Clinical Social Worker 0244745339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exodus Recovery IncGroup PAC ID 2668467341, 16 clinicians

Practice addresses (Care Compare)

12021 S Wilmington Ave
FL 2 Ic1 Ic7
Los Angeles, CA 90059-3019
Phone (562) 295-5916

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
129357CAMDMarriage & Family Therapist
109085CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Exodus Recovery, Inc. CurrentSince Apr 20, 2025 Accepting new patients
Exodus Recovery Inc Current Accepting new patients
Exodus Recovery Inc. CurrentSince Apr 20, 2025 Accepting new patients

Locations

9808 Venice Blvd
Ste 700
Culver City, CA 90232
Phone (310) 253-9494

12021 Wilmington Ave
Fl 2
Los Angeles, CA 90059
Phone (424) 454-5000

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/exodusrecovery/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1215559901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 INDUSTRY WAY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902624024",
            "telephone_number": "310-667-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 INDUSTRY WAY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902624024",
            "telephone_number": "310-667-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAINE",
        "first_name": "CHELSEA",
        "middle_name": "ALEXANDRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-15",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "109085",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "109085",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "129357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

Verify at the official NPI Registry.