Prototypes

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PROTOTYPES

Practice address

831 E Arrow Hwy
Pomona, CA 91767-2535

Phone

(909) 624-1233

NPI assigned

Mar 26, 2020

Organization subpart

No

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

Authorized official

Name

Evanne Bree JacksonNPI 1619506029

Title

Sud Counselor II

Phone

(909) 624-1233

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evanne Bree Jackson

  • Addiction (Substance Use Disorder) Counselor
  • Pomona, CA
  • NPI 1619506029
  NPD Authorized official

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1265069355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 E ARROW HWY",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672535",
            "telephone_number": "909-624-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 E ARROW HWY",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672535",
            "telephone_number": "909-624-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTOTYPES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EVANNE",
        "authorized_official_middle_name": "BREE",
        "authorized_official_title_or_position": "SUD COUNSELOR II",
        "authorized_official_telephone_number": "909-624-1233"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Project Lacey
• Project Sister Family Services
• Joycelin Kinte Prothro, MSW
• Prototypes
• Prototypes
• Prototypes Centers for Innovation - Health, MH, & Social Services
• Prototypes Centers for Innovation in Health, Mental Health and Social
• Prototypes Outpatient Services
• Albert Provencio
• Aleksei Pulchritudoff

• Addiction (Substance Use Disorder) Counselor in Pomona, CA
• Providers in Pomona, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; 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.