Provider Demographics
NPI:1073922415
Name:BAUER, MICHAEL GERALD (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERALD
Last Name:BAUER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:GERALD
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5619 N. FIGUEROA ST.
Mailing Address - Street 2:#223
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4979
Mailing Address - Country:US
Mailing Address - Phone:848-228-3701
Mailing Address - Fax:
Practice Address - Street 1:5619 N. FIGUEROA STREET
Practice Address - Street 2:#223
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:848-228-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X, 106H00000X
CA18-139221700000X
CA102229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100151033Medicaid