Individual provider Active NPI

Shannan A Faust

  • Professional Counselor
  • Los Angeles, CA
National Provider Identifier
1790244135
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11912 Issued in CA
Practice address
470 E 3Rd St Ste C
Los Angeles, CA 90013
Phone
(213) 620-5712
NPI assigned
Mar 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X APCC6920 CA
Behavior Technician 106S00000X
Professional Counselor 101YP2500X 11912 CA Primary

Addresses

Primary practice location

470 E 3Rd St Ste C
Los Angeles, CA 90013

Mailing address

470 E 3Rd St Ste C
Los Angeles, CA 90013-1630
Phone (213) 620-5712

Other practice location 1

3230 E Imperial Hwy
Brea, CA 92821-6721
Phone (657) 444-9002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APCC6920CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. Current Accepting new patients

Locations

470 E 3rd St
Ste C
Los Angeles, CA 90013
Phone (213) 620-4712

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

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.

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1790244135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 E 3RD ST STE C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131630",
            "telephone_number": "213-620-5712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 E 3RD ST STE C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90013",
            "telephone_number": "213-620-5712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3230 E Imperial Hwy",
            "address_purpose": "LOCATION",
            "city": "Brea",
            "state": "CA",
            "postal_code": "928216721",
            "country_code": "US",
            "telephone_number": "657-444-9002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAUST",
        "first_name": "SHANNAN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-15",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "APCC6920",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "11912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.