Provider Demographics
NPI:1639551856
Name:JEANETTE KAY LASATER
Entity Type:Organization
Organization Name:JEANETTE KAY LASATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEDMARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LASATER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-288-2682
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-0238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3734
Practice Address - Country:US
Practice Address - Phone:209-288-2682
Practice Address - Fax:209-288-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40853261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health