Provider Demographics
NPI:1558088583
Name:BARDSLEY, ANITA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3412
Mailing Address - Country:US
Mailing Address - Phone:510-301-7404
Mailing Address - Fax:
Practice Address - Street 1:1250 PINE STREET, SUITE 100/101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-9459
Practice Address - Country:US
Practice Address - Phone:510-301-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist