Provider Demographics
NPI:1992179246
Name:BAHENA, ITZEL ANAHI
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:ANAHI
Last Name:BAHENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2748
Mailing Address - Country:US
Mailing Address - Phone:805-933-8440
Mailing Address - Fax:805-933-0057
Practice Address - Street 1:725 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2748
Practice Address - Country:US
Practice Address - Phone:805-933-8440
Practice Address - Fax:805-933-0057
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health