Active NPI
Jennifer Grant
- Mental Health Counselor
- San Bernardino, CA
National Provider Identifier
1689864241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- N3472135
- Practice address
- 2080 S E St
San Bernardino, CA 92408-2773 - Phone
- (909) 388-9191
- Fax
- (909) 388-9195
- NPI assigned
- Jul 30, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | N3472135 | CA | Primary |
Addresses
Primary practice location
2080 S E St
San Bernardino, CA 92408-2773
Mailing address
PO Box 2768
Fontana, CA 92334-2768
Phone (916) 519-9294
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N3472135 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Telecare Corporation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Maintenance Organization
- San Bernardino, CA
- NPI 1770741282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394582400000",
"number": "1689864241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2768",
"city": "FONTANA",
"state": "CA",
"postal_code": "923342768",
"telephone_number": "916-519-9294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 S E ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082773",
"telephone_number": "909-388-9191",
"fax_number": "909-388-9195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "JENNIFER",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-30",
"last_updated": "2014-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "N3472135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.