Active NPI
Kelly Stephenson, CMA, RADT
- Addiction (Substance Use Disorder) Counselor
- Santa Ana, CA
National Provider Identifier
1972266393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- R1447811021
- Practice address
- 1207 E Fruit St
Santa Ana, CA 92701-4296 - Phone
- (714) 953-9373
- NPI assigned
- Oct 21, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1447811021 | CA | Primary |
Addresses
Primary practice location
1207 E Fruit St
Santa Ana, CA 92701-4296
Mailing address
141 W Olive Ave Apt 1
La Habra, CA 90631-6093
Phone (714) 718-7814
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
- Credentials
- Certified Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1447811021 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643673600000",
"number": "1972266393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 W OLIVE AVE APT 1",
"city": "LA HABRA",
"state": "CA",
"postal_code": "906316093",
"telephone_number": "714-718-7814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 E FRUIT ST",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927014296",
"telephone_number": "714-953-9373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENSON",
"first_name": "KELLY",
"credential": "CMA, RADT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-21",
"last_updated": "2022-02-01",
"certification_date": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1447811021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.