Provider Demographics
NPI:1871625400
Name:LASATER, JEANETTE KAY (MFT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:KAY
Last Name:LASATER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:209-288-2682
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist