Provider Demographics
NPI:1265508121
Name:BAUTZER, RICHARD ALLEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:BAUTZER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 S POINTE DR STE 175
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1538
Mailing Address - Country:US
Mailing Address - Phone:714-543-0483
Mailing Address - Fax:714-543-0483
Practice Address - Street 1:23461 S POINTE DR STE 175
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1538
Practice Address - Country:US
Practice Address - Phone:714-543-0483
Practice Address - Fax:714-543-0483
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40764101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health