Basic Information
| Provider Information | |||||||||
| NPI: | 1750859674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRANTE | ||||||||
| FirstName: | JAKE | ||||||||
| MiddleName: | TERESA | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 675 S ARROYO PKWY STE 420 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242842440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 675 S ARROYO PKWY STE 420 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242842440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2018 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 08/14/2019 | ||||||||
| NPIReactivationDate: | 04/29/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-17558 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | LMFT128809 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.