Active NPI
Jade Star Fewell, PSY.D.ASSISTANT
- Psychologist
- Costa Mesa, CA
National Provider Identifier
1780347237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 94026429
- Practice address
- 3151 Airway Ave Ste J2
Costa Mesa, CA 92626-4624 - Phone
- (949) 702-4677
- NPI assigned
- Oct 20, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15155 | CA | |
| Psychologist | 103T00000X | 94026429 | CA | Primary |
Addresses
Primary practice location
3151 Airway Ave Ste J2
Costa Mesa, CA 92626-4624
Mailing address
PO Box 1946
Laguna Beach, CA 92652-1946
Phone (949) 702-4677
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 |
|---|---|---|---|
| 94026429 | CA | MD | Psychologist |
| 15155 | CA | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640476800000",
"number": "1780347237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1946",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926521946",
"telephone_number": "949-702-4677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3151 AIRWAY AVE STE J2",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926264624",
"telephone_number": "949-702-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEWELL",
"first_name": "JADE",
"middle_name": "STAR",
"name_prefix": "Dr.",
"credential": "PSY.D.ASSISTANT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-20",
"last_updated": "2021-12-26",
"certification_date": "2021-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "15155",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "94026429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.