John Edward Prater Sr.
Counselor, Addiction (Substance Use Disorder) in Pomona, CA. Individual provider (NPI-1).
NPI number1164065041
StatusActive
Last updated in NPPESJul 27, 2021
Details
- NPI
- 1164065041
- Entity type
- Individual (NPI-1)
- Name
- John Edward Prater Sr.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 23, 2019
- Certification date
- Jul 27, 2021
- Last updated
- Jul 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 14576-RAC | CA | Yes |
| 175T00000X | Peer Specialist | – | – |
Practice location
1050 N Garey AvePomona, CA 91767-3802
Phone 909-623-6391 · Fax 909-620-9491
Mailing address
2435 Cienega DrHighland, CA 92346-2295
Phone 219-221-2459
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