Provider Demographics
NPI:1134545445
Name:JEFF BARE LLC
Entity type:Organization
Organization Name:JEFF BARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:717-735-7050
Mailing Address - Street 1:600 OLDE HICKORY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4959
Mailing Address - Country:US
Mailing Address - Phone:717-735-7050
Mailing Address - Fax:717-735-6026
Practice Address - Street 1:600 OLDE HICKORY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4959
Practice Address - Country:US
Practice Address - Phone:717-735-7050
Practice Address - Fax:717-735-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty