Jr'S Trauma Care Initiative

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JR'S TRAUMA CARE INITIATIVE

Practice address

1665 Precision Park LN Ste H
San Ysidro, CA 92173-1348

Phone

(619) 330-7569

NPI assigned

May 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles Elmer Walker, LMFTNPI 1417342957

Title

Director of Mental Health

Phone

(619) 330-7569

Specialties & licenses 5

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Elmer Walker, LMFT

  • Marriage & Family Therapist
  • San Ysidro, CA
  • NPI 1417342957
  NPD Authorized official
• Aaron Carrillo, LCSW

  • Clinical Social Worker
  • Chula Vista, CA
  • NPI 1487934485

  Mental Health

  NPD (past)
• Jessica Moreno-Walker, MA

  • Marriage & Family Therapist
  • Temecula, CA
  • NPI 1851755847
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1205401593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 E SAN YSIDRO BLVD UNIT 483",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921733151",
            "telephone_number": "619-330-7569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 PRECISION PARK LN STE H",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921731348",
            "telephone_number": "619-330-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JR'S TRAUMA CARE INITIATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ELMER",
        "authorized_official_title_or_position": "DIRECTOR OF MENTAL HEALTH",
        "authorized_official_telephone_number": "619-330-7569",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Jane Hrovat
• Berenice Ibanez, PH.D.
• Rachel Ann Ireland, MD
• Christina Iturralde
• Altay Nikkisha Jones Johnson, LVN
• Kent Edward Karras, DC
• Mike Najah Katy
• Mely Knott
• Michele A. Lamantia, MD
• Prescott Michelle Lederer, PA

• Mental Health Clinic/Center (Including Community Mental Health Center) in San Ysidro, CA
• Providers in San Ysidro, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.