Provider Demographics
NPI:1619613031
Name:RESONATE INDIVIDUAL AND FAMILY THERAPY
Entity Type:Organization
Organization Name:RESONATE INDIVIDUAL AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERJAGT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-410-8096
Mailing Address - Street 1:12401 GREEN PASTURE DR
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2916
Mailing Address - Country:US
Mailing Address - Phone:925-658-8367
Mailing Address - Fax:
Practice Address - Street 1:10368 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0427
Practice Address - Country:US
Practice Address - Phone:925-658-8367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty