Provider Demographics
NPI:1386857043
Name:DASBACH, ANNA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:DASBACH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:DASBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:180 7TH AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062
Mailing Address - Country:US
Mailing Address - Phone:831-423-9444
Mailing Address - Fax:831-423-1532
Practice Address - Street 1:180 7TH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062
Practice Address - Country:US
Practice Address - Phone:831-423-9444
Practice Address - Fax:831-423-1932
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52235106H00000X
CAMFC50353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52235OtherINTERN NUMBER