Provider Demographics
NPI:1578887196
Name:LISA BAHAR MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:LISA BAHAR MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-248-4657
Mailing Address - Street 1:14 MONARCH BAY PLZ
Mailing Address - Street 2:SUITE 249
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3424
Mailing Address - Country:US
Mailing Address - Phone:949-248-4657
Mailing Address - Fax:949-493-9350
Practice Address - Street 1:28 MONARCH BAY PLZ
Practice Address - Street 2:SUITE N
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3460
Practice Address - Country:US
Practice Address - Phone:949-248-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty