NPIMap

Organization Active NPI

Casa Serena Eating Disorders Program

  • Marriage & Family Therapist
  • Concord, CA
National Provider Identifier
1629468905
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC25575 Issued in CA
Legal business name
CASA SERENA EATING DISORDERS PROGRAM
Practice address
1868 Clayton Rd
Suite 123
Concord, CA 94520-2547
Phone
(925) 682-8252
Fax
(925) 682-8313
NPI assigned
Jan 26, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Miss Jacquelyn Lee Holmes, MFT
Title
Owner/Director
Phone
(925) 682-8252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X MFC25575 CA Primary

Addresses

Primary practice location

1868 Clayton Rd
Suite 123
Concord, CA 94520-2547

Mailing address

1868 Clayton Rd
Suite 123
Concord, CA 94520-2547
Phone (925) 682-8252

Other names 1

  • Jacquelyn L Holmes Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Casa Serena Eating Disorders Program2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1868 Clayton Rd
Ste 123
Concord, CA 94520
Phone (925) 586-3224

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1629468905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1868 CLAYTON RD",
            "address_2": "SUITE 123",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202547",
            "telephone_number": "925-682-8252",
            "fax_number": "925-682-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1868 CLAYTON RD",
            "address_2": "SUITE 123",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202547",
            "telephone_number": "925-682-8252",
            "fax_number": "925-682-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASA SERENA EATING DISORDERS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "925-682-8252",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC25575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacquelyn L Holmes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.