Individual provider Active NPI

Chantell Janee Fulcher

  • Addiction (Substance Use Disorder) Counselor
  • Gardena, CA
National Provider Identifier
1629664545
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
15519 Crenshaw Blvd
Gardena, CA 90249-4525
Phone
(310) 679-9031
NPI assigned
Dec 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

15519 Crenshaw Blvd
Gardena, CA 90249-4525

Mailing address

15519 Crenshaw Blvd
Gardena, CA 90249-4525
Phone (310) 679-9031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1629664545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15519 CRENSHAW BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494525",
            "telephone_number": "310-679-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15519 CRENSHAW BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494525",
            "telephone_number": "310-679-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULCHER",
        "first_name": "CHANTELL",
        "middle_name": "JANEE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.