Basic Information
| Provider Information | |||||||||
| NPI: | 1023753647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARTAN | ||||||||
| FirstName: | KATY | ||||||||
| MiddleName: | JENAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2495 W MARCH LN STE 125 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952078224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094651080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 302 CHERRY LN | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953374311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096476200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2022 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.