Individual provider Active NPI

Melany Rochelle Fairley, MFT

  • Rehabilitation Practitioner
  • Pasadena, CA
National Provider Identifier
1972770840
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
Practice address
867 N Fair Oaks Ave
Pasadena, CA 91103-3050
Phone
(626) 798-6793
NPI assigned
May 9, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X IMF#95399 CA
Rehabilitation Practitioner 225400000X Primary

Addresses

Primary practice location

867 N Fair Oaks Ave
Pasadena, CA 91103-3050

Mailing address

867 N Fair Oaks Ave
Pasadena, CA 91103-3050
Phone (626) 798-6793

Other practice location 1

205 Pasadena Ave
South Pasadena, CA 91030-2919
Phone (323) 344-5536

Other identifiers 4

IdentifierTypeStateIssuer
7708OtherCAMEDI-CAL
7368OtherCAMEDI-CAL
7667OtherCAMEDI-CAL
7184OtherCAMEDI-CAL

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

LicenseStateTypeSpecialty
IMF#95399CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Institute for the Redesign of Learning Mental Health Past Accepting new patients

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": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525651200000",
    "number": "1972770840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911033050",
            "telephone_number": "626-798-6793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911033050",
            "telephone_number": "626-798-6793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Pasadena Ave",
            "address_purpose": "LOCATION",
            "city": "South Pasadena",
            "state": "CA",
            "postal_code": "910302919",
            "country_code": "US",
            "telephone_number": "323-344-5536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "MELANY",
        "middle_name": "ROCHELLE",
        "name_prefix": "Mrs.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2018-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF#95399",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7708",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7368",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7667",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7184",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; 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.