Basic Information
| Provider Information | |||||||||
| NPI: | 1487927307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAHLER | ||||||||
| FirstName: | MARIANNE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1956 PALMA DR STE J | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930038092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054434561 | ||||||||
| FaxNumber: | 6612661210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1956 PALMA DR STE J | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930038092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054434561 | ||||||||
| FaxNumber: | 6612661210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2012 | ||||||||
| LastUpdateDate: | 05/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 64287 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 77533 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | #95-2633765 | 01 | CA | MEDI-CAL | OTHER |