Basic Information
Provider Information
NPI: 1275736084
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASANTE
FirstName: JANINE
MiddleName: CLAIRE
NamePrefix:  
NameSuffix:  
Credential: MFTI
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 945
Address2:  
City: TEMPLETON
State: CA
PostalCode: 934650945
CountryCode: US
TelephoneNumber: 8054342449
FaxNumber:  
Practice Location
Address1: 71 NORTH MAIN STREET
Address2:  
City: TEMPLETON
State: CA
PostalCode: 93465
CountryCode: US
TelephoneNumber: 8054342449
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/08/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XIMF 51831CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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