Provider Demographics
NPI:1033245907
Name:BOBER, ANTHONY THOMAS (MS,MFT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:BOBER
Suffix:
Gender:M
Credentials:MS,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DOVE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2840
Mailing Address - Country:US
Mailing Address - Phone:949-833-1792
Mailing Address - Fax:949-955-3222
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-833-1792
Practice Address - Fax:949-955-3222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 8086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist