Active NPI
Renee Colleen Bacon
- Counselor
- Big Bear Lake, CA
National Provider Identifier
1639860448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 41945 Big Bear Blvd Ste 222
Big Bear Lake, CA 92315-2030 - Phone
- (909) 809-6657
- NPI assigned
- May 15, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
41945 Big Bear Blvd Ste 222
Big Bear Lake, CA 92315-2030
Mailing address
PO Box 1927
Big Bear Lake, CA 92315-1927
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": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1639860448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1927",
"city": "BIG BEAR LAKE",
"state": "CA",
"postal_code": "923151927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41945 BIG BEAR BLVD STE 222",
"city": "BIG BEAR LAKE",
"state": "CA",
"postal_code": "923152030",
"telephone_number": "909-809-6657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "RENEE",
"middle_name": "COLLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Bear Lake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.