Provider Demographics
NPI:1336261320
Name:BASLER, AMANDA SUSAN (MFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUSAN
Last Name:BASLER
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 1:1717 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4406
Mailing Address - Country:US
Mailing Address - Phone:415-683-1899
Mailing Address - Fax:415-742-4535
Practice Address - Street 1:1717 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4406
Practice Address - Country:US
Practice Address - Phone:415-683-1899
Practice Address - Fax:415-742-4535
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist