Provider Demographics
NPI:1205296530
Name:PARENT WITH PRIDE
Entity type:Organization
Organization Name:PARENT WITH PRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CATABAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LPCC
Authorized Official - Phone:949-791-7452
Mailing Address - Street 1:2850 MESA VERDE DR E
Mailing Address - Street 2:STE. H.
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4891
Mailing Address - Country:US
Mailing Address - Phone:949-791-7452
Mailing Address - Fax:512-682-1750
Practice Address - Street 1:2850 MESA VERDE DR E
Practice Address - Street 2:STE. H.
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4891
Practice Address - Country:US
Practice Address - Phone:949-791-7452
Practice Address - Fax:512-682-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC 1387101YP2500X
CALMFT 49551106H00000X
CALCSW 660761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA109304017OtherN/A
CA1972791192OtherN/A