Provider Demographics
NPI:1780193482
Name:BAEHR, ANITA KATHRYN (LMFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:KATHRYN
Last Name:BAEHR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BAEHR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1037 E BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2345 S ALMA SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4013
Practice Address - Country:US
Practice Address - Phone:602-919-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10401106H00000X
AZ10401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist