Matthew Scott Maclellan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

4125 Temescal St Ste a&C
Fair Oaks, CA 95628-7558

Phone

(916) 877-6894

NPI assigned

Aug 1, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Matthew Scott Crisamore Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1932835931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4125 TEMESCAL ST STE A&C",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287558",
            "telephone_number": "916-877-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 TEMESCAL ST STE A&C",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287558",
            "telephone_number": "916-877-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACLELLAN",
        "first_name": "MATTHEW",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew@thewholesoul.org",
            "affiliation": "N",
            "endpointDescription": "Secure Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client Communication - Nonconfidential",
            "address_1": "4125 Temescal St Ste A&c",
            "city": "Fair Oaks",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956287558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MATTHEW",
            "last_name": "CRISAMORE",
            "middle_name": "SCOTT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Fair Oaks, CA
• Providers in Fair Oaks, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.