Provider Demographics
NPI:1972726826
Name:BARLAS, JUDITH JANET (MFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JANET
Last Name:BARLAS
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 1:1 BODEGA AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2666
Mailing Address - Country:US
Mailing Address - Phone:707-765-9500
Mailing Address - Fax:
Practice Address - Street 1:1 BODEGA AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2666
Practice Address - Country:US
Practice Address - Phone:707-765-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#MFC43882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist