1992302707 NPI number — KALEENA PRATE LICENSED MARRIAGE & FAMILY THERAPIST, INC.

NPI Number: 1992302707
Health Care Provider/Practitioner: KALEENA PRATE LICENSED MARRIAGE & FAMILY THERAPIST, INC.

NPI Number : 1992302707 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992302707",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KALEENA PRATE LICENSED MARRIAGE & FAMILY THERAPIST, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1119 S MISSION RD # 130",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FALLBROOK",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92028-3225",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-209-6602",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "43211 CINCO ARROYOS",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FALLBROOK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92028-8043",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-482-1401",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/05/2020",
    "LastUpdateDate": "10/05/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PRATE",
    "AuthorizedOfficialFirstName": "KALEENA",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "760-209-6602",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM0855X",
          "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}