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General NPI Number Information
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NPI Number | 1639551856
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Entity Type | Organization
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Legal Business Name | JEANETTE KAY LASATER
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 603 W F ST
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City | OAKDALE
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State | CA
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Zip | 95361-3734
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Country | US
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Telephone | 209-288-2682
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Fax | 209-288-2682
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | COLUMBIA
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State | CA
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Zip | 95310-0238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSEDMARRIAGE & FAMILY THERAPIST
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Name | JEANETTE KAY LASATER
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Credential | LMFT
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Telephone | 209-288-2682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LMFT40853
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | LMFT40853
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LMFT40853
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License Number State | CA
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