Active NPI
Michelle Nicole Ulloa
- Marriage & Family Therapist
- Eureka, CA
National Provider Identifier
1508341660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 114781
- Practice address
- 3960 Walnut Dr
Eureka, CA 95503-8938 - Phone
- (707) 268-8722
- Fax
- (707) 268-0218
- NPI assigned
- Sep 25, 2018
- Last updated
- Aug 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Marriage & Family Therapist | 106H00000X | 114781 | CA | Primary |
Addresses
Primary practice location
3960 Walnut Dr
Eureka, CA 95503-8938
Mailing address
3960 Walnut Dr
Eureka, CA 95503-8938
Phone (707) 268-8722
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Roots Curando Raices PC | Marriage & Family Therapist | Current | Accepting new patients |
| Covenant Counseling Center | Past | Accepting new patients | |
| Remi Vista Inc. | Past | Accepting new patients | |
| Remi Vista, Inc. | Past | Accepting new patients |
Locations
3000 Newburg Rd
Ste B
Fortuna, CA 95540
Phone (510) 717-3266
Organizations & group practices 4
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.
-
- Marriage & Family Therapist
- Fortuna, CA
- NPI 1669202537
-
dba six rivers counseling
- Community/Behavioral Health Agency
- Eureka, CA
- NPI 1497923312
-
- Case Management Agency
- Eureka, CA
- NPI 1558314161
-
- Community/Behavioral Health Agency
- Fortuna, CA
- NPI 1982234787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1508341660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3960 WALNUT DR",
"city": "EUREKA",
"state": "CA",
"postal_code": "955038938",
"telephone_number": "707-268-8722",
"fax_number": "707-268-0218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3960 WALNUT DR",
"city": "EUREKA",
"state": "CA",
"postal_code": "955038938",
"telephone_number": "707-268-8722",
"fax_number": "707-268-0218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLOA",
"first_name": "MICHELLE",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-25",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "114781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.