Active NPI
Lee Roy Blackwell, PH.D.
- Counseling Psychologist
- Huntington Beach, CA
National Provider Identifier
1306995089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PSY5642
- Practice address
- 16152 Beach Blvd Ste 170
Huntington Beach, CA 92647-3818 - Phone
- (714) 848-7280
- Fax
- (714) 847-8909
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PSY5642 | CA | Primary |
Addresses
Primary practice location
16152 Beach Blvd Ste 170
Huntington Beach, CA 92647-3818
Mailing address
16152 Beach Blvd Ste 170
Huntington Beach, CA 92647-3818
Phone (714) 848-7280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 16, 2019 through Apr 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY5642 | CA | MD | Counseling Psychologist |
| 5642 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306995089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16152 BEACH BLVD STE 170",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926473818",
"telephone_number": "714-848-7280",
"fax_number": "714-847-8909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16152 BEACH BLVD STE 170",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926473818",
"telephone_number": "714-848-7280",
"fax_number": "714-847-8909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "LEE",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CA",
"license": "PSY5642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.