Provider Demographics
NPI:1346686789
Name:BACHMANN, EDWARD JOHN (MFT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:BACHMANN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4155
Mailing Address - Country:US
Mailing Address - Phone:415-516-0481
Mailing Address - Fax:
Practice Address - Street 1:550 PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4155
Practice Address - Country:US
Practice Address - Phone:415-516-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist