Active NPI
Ixchel Tellez Fonseca, LMFT
- Mental Health Counselor
- Anaheim, CA
National Provider Identifier
1962777904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 111297
- Practice address
- 155 N Riverview Dr
Anaheim, CA 92808-1225 - Phone
- (714) 422-5773
- Fax
- (714) 202-9870
- NPI assigned
- Mar 8, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 111297 | CA | Primary |
Addresses
Primary practice location
155 N Riverview Dr
Anaheim, CA 92808-1225
Mailing address
155 N Riverview Dr
Anaheim, CA 92808-1225
Phone (714) 422-5773
Other names 1
- Ixchel Tellez de Lamkin
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 |
|---|---|---|---|
| 111297 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Journey LLC | Mental Health | Current | Accepting new patients |
Locations
155 N Riverview Dr
Anaheim, CA 92808
Phone (714) 422-5773
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": "1331164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715904000000",
"number": "1962777904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 N RIVERVIEW DR",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928081225",
"telephone_number": "714-422-5773",
"fax_number": "714-202-9870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 N RIVERVIEW DR",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928081225",
"telephone_number": "714-422-5773",
"fax_number": "714-202-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLEZ FONSECA",
"first_name": "IXCHEL",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-08",
"last_updated": "2024-05-17",
"certification_date": "2024-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "111297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "IXCHEL",
"last_name": "TELLEZ DE LAMKIN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.