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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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