Provider Demographics
NPI:1568917995
Name:BAHR, GINNY (LPCC)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:BAHR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151306
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-1306
Mailing Address - Country:US
Mailing Address - Phone:415-450-1149
Mailing Address - Fax:
Practice Address - Street 1:1206 3RD ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3048
Practice Address - Country:US
Practice Address - Phone:415-450-1149
Practice Address - Fax:415-727-1010
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5003101YP2500X
CA2256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional