Active NPI
Good Shepherd Counseling Clinic
- Mental Health Counselor
- Tustin, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFC39965
- Legal business name
- GOOD SHEPHERD COUNSELING CLINIC
- Practice address
- 17461 Irvine Blvd
Suite D
Tustin, CA 92780-3034 - Phone
- (714) 402-0131
- NPI assigned
- Jun 24, 2010
- Last updated
- Jun 24, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Susan Marie Kell, PSYD, MFT
- Title
- Owner
- Phone
- (714) 402-0131
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFC39965 | CA | Primary |
Addresses
Primary practice location
17461 Irvine Blvd
Suite D
Tustin, CA 92780-3034
Mailing address
30713 Riverside Dr
Suite 203
Lake Elsinore, CA 92530-4714
Phone (951) 678-1642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ55205Y | Other | CA | BLUESHIELD |
National Provider Directory
National Provider Directory- Tax ID family
- Good Shepherd Counseling Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Lake Elsinore, CA
- NPI 1649591520
Locations
17461 Irvine Blvd
Ste D
Tustin, CA 92780
Phone (714) 730-0503
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Lake Elsinore, CA
- NPI 1659544708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277337600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1277337600000",
"number": "1467763466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30713 RIVERSIDE DR",
"address_2": "SUITE 203",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925304714",
"telephone_number": "951-678-1642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17461 IRVINE BLVD",
"address_2": "SUITE D",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803034",
"telephone_number": "714-402-0131"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SHEPHERD COUNSELING CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2010-06-24",
"last_updated": "2010-06-24",
"status": "A",
"authorized_official_last_name": "KELL",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "MARIE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "714-402-0131",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSYD, MFT"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "MFC39965",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUESHIELD",
"identifier": "ZZZ55205Y",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.