Basic Information
| Provider Information | |||||||||
| NPI: | 1578779518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAHNER | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MFTI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | GAIL | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 W CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934584303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059222243 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 W CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934584303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059222243 | ||||||||
| FaxNumber: | 8053498165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 03/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 53105 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.