Provider Demographics
NPI:1154654572
Name:BAUS, BETH D (MS)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:D
Last Name:BAUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 MAGNOLIA AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3805
Mailing Address - Country:US
Mailing Address - Phone:951-682-1153
Mailing Address - Fax:951-686-5070
Practice Address - Street 1:7121 MAGNOLIA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3805
Practice Address - Country:US
Practice Address - Phone:951-682-1153
Practice Address - Fax:951-686-5070
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist