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General NPI Number Information
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NPI Number | 1205296530
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Entity Type | Organization
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Legal Business Name | PARENT WITH PRIDE
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 2850 MESA VERDE DR E STE. H.
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City | COSTA MESA
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State | CA
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Zip | 92626-4891
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Country | US
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Telephone | 949-791-7452
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Fax | 512-682-1750
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Provider Business Mailing Address
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Address Line | 2850 MESA VERDE DR E STE. H.
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City | COSTA MESA
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State | CA
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Zip | 92626-4891
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Country | US
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Telephone | 949-791-7452
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Fax | 512-682-1750
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MS. JENNIFER CATABAS
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Credential | MA, LMFT, LPCC
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Telephone | 949-791-7452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC 1387
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 49551
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 66076
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License Number State | CA
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