Provider Demographics
NPI:1326403924
Name:BAHAN, MONICA (LPC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BAHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16395 AVENIDA ATEZADA
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-9097
Mailing Address - Country:US
Mailing Address - Phone:503-308-8549
Mailing Address - Fax:503-974-0957
Practice Address - Street 1:16395 AVENIDA ATEZADA
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-9097
Practice Address - Country:US
Practice Address - Phone:503-308-8549
Practice Address - Fax:503-974-0957
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health