Organization
FULLERTON COUNSELING AND MEDICAL GROUP, INC
Active
Organization
FULLERTON COUNSELING AND MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTINE ANNE PETRIE M.D. (PRESIDENT)
(714) 990-0700
Entity
Organization
Contact information
Practice address
2228 N STATE COLLEGE BLVD, FULLERTON, CA 92831-1361
(714) 990-0700
(714) 990-0142
Mailing address
2228 N STATE COLLEGE BLVD, FULLERTON, CA 92831-1361
(714) 990-0700
(714) 990-0142
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PSY15282
CA
101YM0800X
Mental Health Counselor
PSY6172
CA
103TP0016X
Prescribing (Medical) Psychologist
Primary
C38832
CA
106H00000X
Marriage & Family Therapist
ML012201
CA
Other
Enumeration date
02/14/2007
Last updated
03/26/2015
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