Provider Demographics
NPI:1376028993
Name:BARSTOW HEALTHY LIFESTYLE CONSULTATION INC
Entity Type:Organization
Organization Name:BARSTOW HEALTHY LIFESTYLE CONSULTATION INC
Other - Org Name:BARSTOW PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-515-8215
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92312-0579
Mailing Address - Country:US
Mailing Address - Phone:760-957-7819
Mailing Address - Fax:760-307-5189
Practice Address - Street 1:100 SURREY COURT
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:760-957-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)