Provider Demographics
NPI:1649993122
Name:BARI, ANJUM SHAZIA (MA AMFT)
Entity type:Individual
Prefix:
First Name:ANJUM
Middle Name:SHAZIA
Last Name:BARI
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2676
Mailing Address - Country:US
Mailing Address - Phone:714-730-0930
Mailing Address - Fax:949-540-0173
Practice Address - Street 1:18221 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-2676
Practice Address - Country:US
Practice Address - Phone:714-730-0930
Practice Address - Fax:949-540-0173
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134459106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist