Basic Information
| Provider Information | |||||||||
| NPI: | 1891847307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAYO | ||||||||
| FirstName: | PABLO | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 469 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955020469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072280943 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2259 MYRTLE AVE | ||||||||
| Address2: | CHANGING TIDES FAMILY SERVICES | ||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074448293 | ||||||||
| FaxNumber: | 7074448298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 01/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF # 56524 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 391 | RI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | IMF56524 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.