Provider Demographics
NPI:1578639068
Name:BAYER, CAROL ANNE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:BAYER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41865 BOARDWALK
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9026
Mailing Address - Country:US
Mailing Address - Phone:760-776-5123
Mailing Address - Fax:760-837-1121
Practice Address - Street 1:41865 BOARDWALK
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:760-776-5123
Practice Address - Fax:760-837-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist