Provider Demographics
NPI:1982846572
Name:BATHURST, PATRICIA ELLEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:BATHURST
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 1:1850 E VIA ESCUELA
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3560
Mailing Address - Country:US
Mailing Address - Phone:760-972-7194
Mailing Address - Fax:
Practice Address - Street 1:500 S PALM CANYON DR
Practice Address - Street 2:STE. 203
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7472
Practice Address - Country:US
Practice Address - Phone:760-972-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist