Fullerton Counseling and Medical Group, Inc

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

C38832 Issued in CA

Legal business name

FULLERTON COUNSELING AND MEDICAL GROUP, INC

Practice address

2228 N State College Blvd
Fullerton, CA 92831-1361

Phone

(714) 990-0700

Fax

(714) 990-0142

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Justine Anne Petrie, M.D.

Title

President

Phone

(714) 990-0700

Specialties & licenses 4

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John C Gardner, ML-012201

  • Marriage & Family Therapist
  • Fullerton, CA
  • NPI 1932322484
  NPD (past)
• Kimberly Marie Hagan, PHD

  • Clinical Psychologist
  • Fullerton, CA
  • NPI 1861584922
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1821131673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2228 N STATE COLLEGE BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311361",
            "telephone_number": "714-990-0700",
            "fax_number": "714-990-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2228 N STATE COLLEGE BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311361",
            "telephone_number": "714-990-0700",
            "fax_number": "714-990-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON COUNSELING AND MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "PETRIE",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-990-0700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSY6172",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSY15282",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "CA",
            "license": "C38832",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "ML012201",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prescribing (Medical) Psychologist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Prescribing (Medical) Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.