Healthcare Provider Details

I. General information

NPI: 1992302707
Provider Name (Legal Business Name): KALEENA PRATE LICENSED MARRIAGE & FAMILY THERAPIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43211 CINCO ARROYOS
FALLBROOK CA
92028-8043
US

IV. Provider business mailing address

1119 S MISSION RD # 130
FALLBROOK CA
92028-3225
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-1401
  • Fax:
Mailing address:
  • Phone: 760-209-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KALEENA E PRATE
Title or Position: PRESIDENT
Credential:
Phone: 760-209-6602