Provider Demographics
NPI:1285212613
Name:BAHNS, MAXINE (AMFT)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:BAHNS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N. REINO RD
Mailing Address - Street 2:#214
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3710
Mailing Address - Country:US
Mailing Address - Phone:310-569-2572
Mailing Address - Fax:
Practice Address - Street 1:107 N. REINO RD
Practice Address - Street 2:#214
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3710
Practice Address - Country:US
Practice Address - Phone:310-569-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty