Provider Demographics
NPI:1407960982
Name:OHANNESON, BETH (BETH OHANNESON, MFT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:OHANNESON
Suffix:
Gender:F
Credentials:BETH OHANNESON, MFT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:OHANNESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:45 FRANKLIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6017
Mailing Address - Country:US
Mailing Address - Phone:415-564-0782
Mailing Address - Fax:
Practice Address - Street 1:45 FRANKLIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6017
Practice Address - Country:US
Practice Address - Phone:415-564-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39243ZOtherBLUE SHIELD PIN
CA94-3237498OtherSOLE PROPRIETOR