Provider Demographics
NPI:1952653966
Name:BAZELEY, RITA (MFT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BAZELEY
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 1:12725 VENTURA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2437
Mailing Address - Country:US
Mailing Address - Phone:213-300-5295
Mailing Address - Fax:
Practice Address - Street 1:12725 VENTURA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2437
Practice Address - Country:US
Practice Address - Phone:213-300-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist