=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891671285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUNDATIONAL ROOTS FAMILY THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27281 LAS RAMBLAS STE 254
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27281 LAS RAMBLAS STE 254
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ LMFT
-----------------------------------------------------
Name | JANELLE B. SANTUCCI
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 714-519-6433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------