Provider Demographics
NPI:1972021632
Name:BASTIAO, ASHLI (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:
Last Name:BASTIAO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 CLAY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1874
Mailing Address - Country:US
Mailing Address - Phone:209-678-1534
Mailing Address - Fax:
Practice Address - Street 1:2485 CLAY ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1874
Practice Address - Country:US
Practice Address - Phone:415-329-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist