Provider Demographics
NPI:1942798657
Name:BASES, DARLENE (MFT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:BASES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:JOY
Other - Last Name:MANICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:20301 VENTURA BLVD STE 336
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0956
Mailing Address - Country:US
Mailing Address - Phone:818-713-1312
Mailing Address - Fax:
Practice Address - Street 1:20301 VENTURA BLVD STE 336
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0956
Practice Address - Country:US
Practice Address - Phone:818-713-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist